Impact of carbapenem‐resistant K lebsiella pneumoniae ( CR ‐ KP ) infections in kidney transplantation

Background Carbapenem‐resistant K lebsiella pneumoniae ( CR ‐ KP ) infections in solid organ transplant patients are progressively increasing and are associated with worse outcomes, although potential risk factors and therapeutic strategies are still not well defined. Methods We conducted a retrospective matched‐pair analysis in which we compared 26 recipients CR ‐ KP ‐positive after kidney transplantation ( KT ) with 52 CR ‐ KP ‐negative patients transplanted in the same period, during a CR ‐ KP outbreak that occurred in our hospital. Twenty‐one patients (80%) received a combined antibiotic treatment. At the end of the follow‐up, of the 26 CR ‐ KP infected patients, 11 (42.3%) experienced at least one episode of re‐infection, 9 (34.6%) remained colonized, and 6 (23.0%) had a symptomatic infection. Two of the 11 patients with re‐infection died, while 9 were colonized at the end of the study. Results A significantly better patient ( P  = .043) and graft ( P  < .001) survival was observed in CR ‐ KP ‐negative patients. Univariate analysis identified the following variables as potential risk factors associated with CR ‐ KP infection after KT : lower body mass index ( P  = .020); higher creatinine levels at post‐transplant days 7 ( P  = .009), 15 ( P  = .026), and 30 ( P  = .019); longer hospital stay ( P  = .007); longer cold ischemia time ( P  = .004); delayed graft function ( P  = .020); and higher Clavien‐Dindo score ( P  = .006). Conclusion The study confirmed that a CR ‐ KP positivity may affect the outcome of a kidney transplant population. In severe CR ‐ KP infections with sepsis, a combined antibiotic treatment seems to be advisable.