Prevention and treatment of graft-carried carbapenem-resistant Klebsiella pneumoniae infection after kidney transplantation: a report of 13 cases

Objective To evaluate the efficacy of tigecycline plus prolonged high-dose meropenem infusion in the prevention and treatment of early carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after renal transplantation. Methods From January 2016 to December 2018, clinical data were retrospectively analyzed for 13 renal transplant recipients with graft-carried CRKP. The relevant clinical data included treatments and outcomes of grafts and recipients.KPC-2 gene was the only resistance gene detectable in all isolates of CRKP. Among 13 CRKP positive recipients, there were positive cultures of graft preservation solution, recipient blood & urine (n=1), positive cultures of graft preservation solution & urine (n=1), positive cultures of graft preservation solutions & peri-graft drainage (n=3), continuous positive cultures of peri-graft drainage more than twice (n=3) and positive culture of graft preservation solution (n=5). All patients received tigecycline plus prolonged high-dose meropenem infusion-based antibiotics. Results Five patients with CRKP positive in preservation solution were successfully prevented from infection after a treatment period of (12.4±2.1)days. Among another 8 cases, additional topical medications (n=3) and surgical debridement (n=1) were used. It took a median time of 16 (7~60) days until a negative culture and the total antibiotic treatment course was 20 (10~93) days. The average hospitalization duration was (50±35) days. During a median follow-up period of 25 (6~28) months, there was no onset of renal arterial rupture, graft nephrectomy or death. The survival rate was 100% for recipients and 92.3% for grafts. Conclusions For post-transplant infections due to graft-carried KPC-2 producing CRKP, rapid diagnostics and tigecycline plus prolonged high-dose meropenem infusion may optimize clinical outcomes by decreasing the rate of graft nephrectomy and the recipient mortality. Key words: Kidney transplantation; Donor; Klebsiella pneumoniae; Infection; Prognosis