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. 2015 Dec;21(12):1511-9.
doi: 10.1002/lt.24207.

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients

Marcus R Pereira  1 , Brendan F Scully  2   3 , Stephanie M Pouch  4 , Anne-Catrin Uhlemann  1   2 , Stella Goudie  5 , Jean E Emond  3   5 , Elizabeth C Verna  2   3   5
Affiliations

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections in liver transplant recipients

Marcus R Pereira et al. Liver Transpl. 2015 Dec.

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is increasing in incidence and is associated with increased mortality in liver transplantation (LT) recipients. We performed a retrospective cohort study of all patients transplanted between January 2010 and January 2013 to identify the incidence and risk factors for post-LT CRKP infection and evaluate the impact of this infection on outcomes in a CRKP-endemic area. We studied 304 recipients, of whom 20 (6.6%) developed CRKP and 36 (11.8%) carbapenem-susceptible Klebsiella pneumoniae (CSKP) infections in the year following LT. Among the 20 recipients with post-LT CRKP infection, 8 (40%) were infected in ≥ 2 sites; 13 (65%) had surgical site-intra-abdominal infections; 12 (60%) had pneumonia; and 3 (15%) had a urinary tract infection. There were 6 patients with a CRKP infection before LT, 5 of whom developed a CRKP infection after LT. Significant risk factors for post-LT CRKP infection in multivariate analysis included laboratory Model for End-Stage Liver Disease at LT (odds ratio [OR], 1.07; P = 0.001), hepatocellular carcinoma (OR, 3.19; P = 0.02), Roux-en-Y biliary choledochojejunostomy (OR, 3.15; P = 0.04), and bile leak (OR, 5.89; P = 0.001). One-year estimated patient survival was 55% (95% confidence interval, 31%-73%), 72% (55%-84%), and 93% (89%-96%), for patients with CRKP, CSKP, and no Klebsiella pneumoniae infection, respectively. In multivariate analysis, CRKP (hazard ratio [HR], 6.92; P < 0.001) and CSKP infections (CSKP, HR, 3.84; P < 0.001), as well as bile leak (HR, 2.10; P = 0.03) were the strongest predictors of post-LT mortality. In an endemic area, post-LT CRKP infection is common, occurring in 6.6% of recipients, and is strongly associated with post-LT mortality. Improved strategies for screening and prevention of CRKP infection are urgently needed.

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Conflict of interest statement

Potential conflict of interest: Nothing to report.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis comparing recipient survival between patients with post-LT CRKP infection, CSKP infection, and those without KP infection.
See this image and copyright information in PMC

Comment in

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