Carbapenem-resistantKlebsiella pneumoniaecolonization at liver transplantation: A management challenge

Abstract

(CR-KP) and perhaps to die for this infection (1-4). Hence, different preventive strategies for patients colonized with CR-KP have been advocated, varying from the selective intestinal decontamination to the avoidance of transplantation. However, literature data on the real incidence and timing of invasive infection with CR-KP among colonized patients underwent LT are limited and confusing. To investigate the incidence rate of post surgical CR-KP infection within 30 and 60 days after LT among patients colonized and no colonized at transplantation, we performed a matched case-control study at our 1,350-bed teaching hospital, from July 2011 to June 2013. Matching was performed at a ratio of 1:2 according to the age, sex and Model-for End-stage-Liver-Disease (MELD) score before transplantation. If there were several potential matching control patients, the control patient closest to the case patient in age and MELD was selected. Each patient was included only once. Rectal swabs (RSs) for carrying out colonization with CR-KP were routinely performed in all LT candidates monthly until LT, and at the time of hospital admission immediately prior to transplant. RSs were then repeated every week after LT until hospital discharge. Isolation and contact precautions were activated for patients found to be CR-KP carriers, but no eradication treatment was started in patients without invasive disease. Samples were inoculated on a chromogenic agar plate (Oxoid Brilliance CRE, Thermo Fisher Scientific, United Kingdom) containing a carbapenem antibiotic as selective agent. Biochemical identification and antimicrobial susceptibility testing of isolates were further carried out using the Vitek 2 semi-automated system (Biomerieux, Marcy l’Etoile, France). Overall, 10 out of the 139 (7.2%) patients admitted for LT were found to be CR-KP carriers at LT. Comparison of cases and controls is shown in Table 1. Page 3 of 7John Wiley & Sons, Inc.Liver Transplantation