Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation.

Fei Zhang,Guiyi Liao,Yiding Chen,Jinbiao Zhong,Handong Ding,Tianchi Lan,Jing Yang,Jiashan Pan

doi:10.3389/fcimb.2021.726282

Abstract

BackgroundInfections remain a major cause of morbidity and mortality in kidney transplant (KT) recipients. This study was performed to identify the overall prevalence of early infections, prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after KT, one-year postoperative mortality in patients with early infections and risk factors for CRKP infections.MethodsWe conducted a retrospective study of all patients who received KT in our hospital between January 2017 and December 2019. We evaluated the demographic, clinical, infection characteristics and the one-year postoperative outcomes.ResultsAmong the 419 patients who received KT between January 2017 and December 2019, 150 patients had at least one infection within 90 days after KT. The total prevalence of early infections was 36.1% (150/415), the prevalence of early CRKP infections was 10.4% (43/415), and the one-year postoperative mortality was 15.3% (23/150) in patients with early infections. The risk factors independently related to one-year postoperative mortality were mechanical ventilation (MV) > 48 h (Odds ratio (OR)= 13.879, 95%Confidence interval (CI): 2.265~85.035; P=0.004) and CRKP infection (OR=6.751, 95% CI: 1.051~43.369; P =0.044). MV> 48 h was independently related to CRKP infection (OR=3.719, 95% CI: 1.024~13.504; P=0.046). Kaplan-Meier survival curves showed that the one-year survival rate of patients infected with CRKP in the early postoperative stage was significantly lower than that of uninfected patients.ConclusionsIn general, the prevalence of early infections after KT is high, and CRKP infection is closely correlated with poor prognosis. The effective prevention and treatment of CRKP infection is an important way to improve the one-year survival rate after KT.

Highlights

Solid organ transplant (SOT) recipients have a higher risk of infection than other populations, mainly due to the following reasons: transplantation from marginal donors, especially infected donors; surgical intervention; and the use of immunosuppressants (Linares et al, 2010)
In the analysis of the risk factors for one-year mortality in the patients with early infections, we evaluated age, sex, donor type, diabetes mellitus, etiology of renal failure, acute rejection, site of infection, delayed graft function (DGF), anti-thymocyte globulin induction, mechanical ventilation (MV) > 48 h, multiple infections, fungal infection, cytomegalovirus (CMV) infection, multifocal infections, mixed infections, multidrug-resistant (MDR) bacterial infection, carbapenem-resistant Klebsiella pneumoniae (CRKP) infection, postoperative leukopenia, reintervention and the length of ICU(intensive care unit) stay
According to the medical records, 419 patients received KT between January 2017 and December 2019, a total of 419 patients received kidney transplantation, three recipients with lost follow-up data and one recipient who died within 48 hours after KT were excluded, 150 of the 415 included recipients recorded at least one infection within 90 days after transplantation

Summary

Introduction

Solid organ transplant (SOT) recipients have a higher risk of infection than other populations, mainly due to the following reasons: transplantation from marginal donors, especially infected donors; surgical intervention; and the use of immunosuppressants (Linares et al, 2010). In CRKPendemic areas, the mortality rate of SOT recipients infected with CRKP was estimated to be close to 40%, which is approximately 3-5 times higher than that of non-CRKP-infected recipients (Kalpoe et al, 2012; Clancy et al, 2013; Pouch et al, 2015). These data indicate that early infection after transplantation, especially with CRKP, is related to a poor prognosis of the recipient. This study was performed to identify the overall prevalence of early infections, prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after KT, one-year postoperative mortality in patients with early infections and risk factors for CRKP infections

Methods

Results

Conclusion