KPC Klebsiella Identification Significantly Increases Risk of Bronchial Dehiscence in Lung Transplant Recipients

Abstract

Purpose Klebsiella pneumoniae is commonly isolated early after lung transplantation . Bronchial complications can cause significant morbidity and mortality in lung transplantation. Between 2015 and 2017, our institution observed an increased rate of bronchial complications after an outbreak of carbapenemase-producing (KPC) Klebsiella. This study examined the association between bronchial complications and KPC Klebsiella. Methods 173 patients who underwent bilateral lung transplantation from 2012 to 2018 in our institute were enrolled. The KPC Klebsiella group was defined as positive for KPC isolation from sputum or bronchoalveolar lavage fluid . A bronchial complication was defined as a positive finding on bronchoscopy according to ISHLT criteria. We analyzed pre- and postoperative data including risk factors for bronchial complications. Results KPC Klebsiella was identified in 29 cases (16.8%), bronchial necrosis in 47 (27.2%), and bronchial dehiscence in 13 (7.5%). Recipient smoking (OR 2.014, p=0.045), duration of donor mechanical ventilation (OR 1.005, p=0.008), Aspergillus infection (OR 3.205, p=0.001), and multidrug-resistant infection (OR 2.452, p=0.032) were associated with bronchial necrosis. Recipient smoking (OR 6.392, p=0.018), KPC Klebsiella identification (OR 5.106, p=0.007), and bronchial necrosis (OR 7.224, p=0.002) were associated with bronchial dehiscence. On multivariate analysis , Aspergillus infection (OR 2.997, p=0.014) was significantly associated with bronchial necrosis, and KPC Klebsiella identification (OR 5.970, p=0.039) and bronchial necrosis (OR 10.47, p=0.047) were significantly associated with bronchial dehiscence. Conclusion KPC Klebsiella identification significantly increased the risk of bronchial dehiscence, independent of bronchial necrosis. Patients with KPC Klebsiella identification require more frequent follow-up bronchoscopy, even if they have no bronchial necrosis and good general condition.