Carbapenem-Resistant Klebsiella Pneumoniae Infections Early After Liver Transplantation: A Single-Center Experience

The aims of this study were to define in a cohort of 310 liver transplant recipients, the incidence of post–liver transplantation (LT) non–carbapenem-resistant Klebsiella pneumoniae (CRKP) and CRKP infections, pre- and post-LT CRKP colonization, CRKP-associated mortality, and risk factors for non-CRKP and CRKP infections. Every patient was screened for CRKP immediately before and after LT. The 6-month survival rate was 95%. Fifty-two patients became infected (16.5%): 8 by CRKP (2.5%) and 44 (14%) by a non-CRKP micro-organism. Median onset of CRKP infections occurred at postoperative (POD) 12 (range, 4–70). CRKP colonization occurred in 20 patients (6%): 10 before LT (3 infected and died) and 10 after (5 infected, 3 died). CRKP- versus non-CRKP–infected patients had higher rates of intensive care unit (ICU) and hospital mortality (50% vs 20% and 62.5% vs 36%; P ≤ .001), septic shock (87% vs 34%; P = .0057; confidence interval [CI], 9.8–71.5), prolonged mechanical ventilation (100% vs 64%; P = .043, CI, 3.5–51.9), and renal replacement therapy (87% vs 41%; P = .0177; CI, 2.8–65). The small number of CRKP-infected patients did not allow the definition of specific risk factors for CRKP infection. At univariate analysis, pre- and post-LT colonization (odds ratio [OR], 10.76; CI, 2.6–44; OR, 14.99; CI, 3.83–58.66, respectively), relaparotomy (OR, 9.09; CI, 4.01–20.6), retransplantation (OR, 7.45; CI, 3.45–16), bile leakage (OR, 61.28; CI, 9.23–80), and early allograft dysfunction (EAD; OR, 5.7; CI, 3–10.7) were significantly associated with infections, making CRKP colonization (any time) and post-LT surgical and medical complications critical factors for post-LT CRKP infections.