Diagnosis and treatment in 9 cases of donor-derivedcarbapenem-resistant Klebsiella pneumoniae Infection after kidney transplantation

Objective To explore the rapid diagnosis and clinic treatment of donor-derived carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in renal transplant recipients. Methods Retrospective analysis was performed for clinical data and the diagnosis and treatment of 9 renal transplant recipients with donor-derived CRKP infection from March 2017 to May 2019. Results Among 526 renal transplant recipients, nine were diagnosed with donor-derived CRKP infection by bacterial culture or KPC enzyme gene test. The infection rate was 1.71%. One recipient receiving carbapenem and tigecycline died while the remainders survived after a treatment of ceftazidime-avibactam and carbapenem. One recipient underwent graft resection. Among 8 recipients on ceftazidime-avibactam, 5 cases received a standard dose of 3.75 g/d while another 3 cases had a high dose of 7.5 g/d. One patient in standard-dose group underwent graft resection due to an arteriorrhexis of artery anastomosis. After graft resection, the patient received a high dose of ceftazidime-avibactam and survived to date. The grafts of three patients in high-dose treatment group survived. Conclusions KPC enzyme gene detection plus injecting lavage fluid into blood culture bottle for bacterial culture is rapid and accurate for diagnosing donor-derived CRKP infection. A combination of ceftazidime-avibactam plus carbapenem is effective for donor-derived CRKP infection. A high dose of ceftazidime-avibactam may improve the efficacy without obvious side effects. Key words: Renal transplantation; infection; resistant organism