Risk of KPC-Klebsiella pneumoniae (KPC-Kp) donor-derived disease in transplant recipients: the experience at a tertiary teaching hospital in Italy. Objectives. Infection due to KPC-Kp has been recently recognized as an important complication in transplant patients, associated with increased therapeutic failure and mortality. National guidelines provide provisions on criteria and methods for suitability and certification of organ and tissue taken for the purpose of transplantation. Exclusion criteria include presence of clinical evidence of KPC-Kp infection, but the question of colonized patients remains unsolved. Colonizations that are not rapidly identified in the donor can be transmitted to the recipient(s). Here we report the results of the screening carried out on potential donors attending a tertiary teaching hospital, national reference center for liver, kidney and pancreas transplantation. Outcome of transplant patients followed by the Infectious Diseases specialists involved in the follow-up of transplant patients is also reported. Methods. In the 1077-bed teaching hospital the KPC-Kp outbreak started in April 2010. In two years time, 48 potential donors were screened, 30 of which admitted to the 10-bed Intensive Care Unit (ICU), regional referral center for trauma patients, and 18 admitted to the neurosurgery-ICU. The reference laboratory conducted the analysis for assessing the donor suitability on 151 different clinical samples, mainly blood, bronchial aspirate, urine and rectal swab. Species identification and antimicrobial susceptibilitiy were obtained by Vitek2 and KPC production detected by phenotypic inhibitory activity and molecular methods. Eighteen transplant patients required the opinion of the infectious diseases physician, 9 of them were solid organ recipients. Results. KPC-Kp was recognized in 73 of 151 clinical samples obtained from potential donors(48%), followed by MDR Pseudomonas aeruginosa on 40% of samples (60/151). KPC-Kp were isolated from 41 rectal swabs, 14 bronchial aspirates, 8 urine, 4 blood, 1 organ fragment, 1 bile, 2 ascitic fluids and 2 skin swabs. Transplant patients, 13 on 18 (72%) resulted infected by KPC-Kp and 5 (28%) colonized. Posttransplant KPC-Kp mortality was 31% (2 sepsis and 2 bacteraemic pneumonia). Conclusions. A quick, accurate diagnosis of KPC-producing strains in potential donors reduces the possibility of serious infections in recipients; equally important is the adoption of strict adherence to infection control measures and antimicrobial stewardship in posttransplant ICUs.
Risk of KPC-Klebsiella pneumoniae (KPC-Kp) donor-derived disease in transplant recipients: the experience at a tertiary teaching hospital in Italy
CASINI, BEATRICE;Tascini C;PRIVITERA, GAETANO PIERPAOLO
2013-01-01
Abstract
Risk of KPC-Klebsiella pneumoniae (KPC-Kp) donor-derived disease in transplant recipients: the experience at a tertiary teaching hospital in Italy. Objectives. Infection due to KPC-Kp has been recently recognized as an important complication in transplant patients, associated with increased therapeutic failure and mortality. National guidelines provide provisions on criteria and methods for suitability and certification of organ and tissue taken for the purpose of transplantation. Exclusion criteria include presence of clinical evidence of KPC-Kp infection, but the question of colonized patients remains unsolved. Colonizations that are not rapidly identified in the donor can be transmitted to the recipient(s). Here we report the results of the screening carried out on potential donors attending a tertiary teaching hospital, national reference center for liver, kidney and pancreas transplantation. Outcome of transplant patients followed by the Infectious Diseases specialists involved in the follow-up of transplant patients is also reported. Methods. In the 1077-bed teaching hospital the KPC-Kp outbreak started in April 2010. In two years time, 48 potential donors were screened, 30 of which admitted to the 10-bed Intensive Care Unit (ICU), regional referral center for trauma patients, and 18 admitted to the neurosurgery-ICU. The reference laboratory conducted the analysis for assessing the donor suitability on 151 different clinical samples, mainly blood, bronchial aspirate, urine and rectal swab. Species identification and antimicrobial susceptibilitiy were obtained by Vitek2 and KPC production detected by phenotypic inhibitory activity and molecular methods. Eighteen transplant patients required the opinion of the infectious diseases physician, 9 of them were solid organ recipients. Results. KPC-Kp was recognized in 73 of 151 clinical samples obtained from potential donors(48%), followed by MDR Pseudomonas aeruginosa on 40% of samples (60/151). KPC-Kp were isolated from 41 rectal swabs, 14 bronchial aspirates, 8 urine, 4 blood, 1 organ fragment, 1 bile, 2 ascitic fluids and 2 skin swabs. Transplant patients, 13 on 18 (72%) resulted infected by KPC-Kp and 5 (28%) colonized. Posttransplant KPC-Kp mortality was 31% (2 sepsis and 2 bacteraemic pneumonia). Conclusions. A quick, accurate diagnosis of KPC-producing strains in potential donors reduces the possibility of serious infections in recipients; equally important is the adoption of strict adherence to infection control measures and antimicrobial stewardship in posttransplant ICUs.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
