Abstract
Objectives: Klebsiella pneumoniae carbapenemase (KPC)–producing K. pneumoniae (KPC-Kp) emerge as a major healthcare concern worldwide. Despite the significance of infections before and after allogeneic hematopoietic cell transplantation (alloHCT), the burden of KP infections has not been extensively evaluated.Methods: We studied the incidence, risk factors, and outcomes of consecutive alloHCT recipients with Kp isolates before and after alloHCT.Results: Among 424 patients who underwent alloHCT in 2008–2018, we studied two groups: those with Kp isolates before (group 1, 52 patients) and those with Kp isolates after alloHCT (group 2, 66 patients). prE-transplant infections were associated with post-transplant infections (p = 0.010), despite secondary prophylaxis. KPC-Kp was isolated in 29% of group 1, and 80% of group 2. Both groups were characterized by a significant burden of moderate–severe acute graft- vs.-host disease (GVHD) [cumulative incidence (CI) of 44.5 and 61.9%, respectively] and severe chronic (CI of 56.7 and 61.9%). Kp infections and GVHD were independent predictive factors of treatment-related mortality (TRM) in both groups.Conclusions: Our study highlights the significant impact of Kp infections on TRM, with GVHD consisting an important underlying factor. As prophylactic measures did not improve rates of post-transplant infections, innovative interventions need to be further investigated to address this major healthcare concern.
Highlights
Infections remain a major determinant of morbidity and mortality post–allogeneic hematopoietic cell transplantation [1]
Among 424 transplanted patients, we studied 52 patients with Kp isolates before and 66 patients with Kp isolates after allogeneic hematopoietic cell transplantation (alloHCT)
None of the studied pre-transplant and transplant factors has been associated with Kp infections
Summary
Infections remain a major determinant of morbidity and mortality post–allogeneic hematopoietic cell transplantation (alloHCT) [1]. AlloHCT recipients are at high risk of bacteremia early after transplantation because of two major insults to their innate immune system These patients have rather prolonged neutropenia after receipt of their conditioning regimen and lack the Klebsiella pneumoniae in Allogeneic Hematopoietic Cell Transplantation first and most important phagocytes to combat bacterial infections [2]. Their conditioning regimen leads to marked gastrointestinal (GI) mucositis, and the integrity of their mucosal barrier is damaged. Bloodstream infections (BSIs) occur in 20 to 50% of alloHCT recipients, especially during neutropenia, and have been associated with poor morbidity and mortality [3,4,5,6]
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