Summary of treatment experience of carbapenem-resistant Klebsiella pneumoniae infection after renal transplantation in DCD era
10.3969/j.issn.1674-7445.2020.01.012
- VernacularTitle:DCD时代肾移植术后耐碳青霉烯类肺炎克雷伯菌感染的治疗经验总结
- Author:
Yanzhong LIU
1
;
Hongwei BAI
;
Yeyong QIAN
;
Bingyi SHI
;
Jingyuan CHANG
;
Chao LI
;
Gang LI
;
Junjie XIE
;
Fei YU
Author Information
1. Second Department of Urology, the Eighth Medical Center of Chinese PLA General Hospital, Beijing 100091, China
- Publication Type:Research Article
- Keywords:
Renal transplantation;
Carbapenem-resistant Klebsiella pneumoniae;
Donation after cardiac death;
Bacterial culture;
Donor-derived infection;
Drug-resistant bacterial infection;
Tigecycline;
Meropenem;
Avibactam
- From:
Organ Transplantation
2020;11(1):76-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the clinical treatment experience of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation in donation after cardiac death (DCD) era. Methods Clinical data of 10 donors and 17 recipients with CRKP infection after DCD renal transplantation from January 2015 to January 2019 were retrospectively analyzed. Both donors and recipients received bacterial culture and drug sensitivity test. Clinical manifestations, treatment and outcome of CRKP-infected recipients were recorded. Results Seven donors were infected with CRKP. After pretreatment, CRKP in 2 cases turned negative, CRKP in 5 donors did not turn negative. All renal grafts were treated with tigecycline+meropenem+voriconazole lavage to prevent infection. Among 17 recipients with CRKP infection, 11 cases were positive for blood culture, 10 positive for urine culture, 3 positive for sputum culture, 3 positive for incisional secretion and 3 positive for retroperitoneal drainage. Clinical manifestations included fever in 8 cases, rupture and hemorrhage of the transplant renal artery in 7 cases or thrombosis in the transplant renal artery in 1 case, bladder irritation sign in 3 cases and cough with brick red jelly-like sputum in 1 case, respectively. Five patients were treated with tigecycline+meropenem, 1 patient suffered from renal graft loss and 4 recipients died. Twelve patients were treated with ceftazidime-avibactam +meropenem, 3 patients presented with renal graft loss and 1 recipient died. Conclusions CRKP-infected donor is not the absolute contraindication of renal transplantation. Pretreatment of donor infection and early administration of sufficient sensitive antibiotics can cure CRKP infection and improve the clinical prognosis of renal transplant recipients.
