Prevention and treatment of graft-carried carbapenem-resistant Klebsiella pneumoniae infection after kidney transplantation:a report of 13 cases
10.3760/cma.j.issn.0254-1785.2019.06.003
- VernacularTitle:肾移植术后供肾来源CRKP感染13例成功防治的临床经验
- Author:
Lan ZHU
1
;
Zhiqiang WANG
;
Ke MA
;
Hao FENG
;
Guangyuan ZHAO
;
Jindong JIA
;
Xinqiang WANG
;
Zhengbin LIN
;
Gang CHEN
Author Information
1. 华中科技大学同济医学院附属同济医院器官移植研究所 器官移植教育部重点实验室国家卫生健康委员会器官移植重点实验室 中国医学科学院器官移植重点实验室
- Keywords:
Kidney transplantation;
Donor;
Klebsiella pneumoniae;
Infection;
Prognosis
- From:
Chinese Journal of Organ Transplantation
2019;40(6):328-333
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the efficacy of tigecycline plus prolonged high-dose meropenem infusion in the prevention and treatment of early carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation .Methods From January 2016 to December 2018 ,clinical data were retrospectively analyzed for 13 renal transplant recipients with graft-carried CRKP .The relevant clinical data included treatments and outcomes of grafts and recipients .KPC-2 gene was the only resistance gene detectable in all isolates of CRKP . Among 13 CRKP positive recipients ,there were positive cultures of graft preservation solution ,recipient blood & urine (n=1) , positive cultures of graft preservation solution & urine (n=1) ,positive cultures of graft preservation solutions & peri-graft drainage (n=3) ,continuous positive cultures of peri-graft drainage more than twice (n= 3) and positive culture of graft preservation solution (n= 5).All patients received tigecycline plus prolonged high-dose meropenem infusion-based antibiotics .Results Five patients with CRKP positive in preservation solution were successfully prevented from infection after a treatment period of (12 .4 ± 2 .1)days .Among another 8 cases ,additional topical medications (n= 3) and surgical debridement (n= 1) were used .It took a median time of 16 (7～60) days until a negative culture and the total antibiotic treatment course was 20 (10～93) days .The average hospitalization duration was (50 ± 35) days .During a median follow-up period of 25 (6～28) months ,there was no onset of renal arterial rupture ,graft nephrectomy or death .The survival rate was 100％ for recipients and 92 .3％ for grafts .Conclusions For post-transplant infections due to graft-carried KPC-2 producing CRKP ,rapid diagnostics and tigecycline plus prolonged high-dose meropenem infusion may optimize clinical outcomes by decreasing the rate of graft nephrectomy and the recipient mortality .
