Risk Factors and Outcomes of Klebsiella pneumoniae Infection Before and After Allogeneic Hematopoietic Cell Transplantation

Frontiers in Medicine

article

Eleni Gavriilaki¹  Christos Demosthenous¹  Zoi Bousiou¹  Varnavas Constantinou¹  Damianos Sotiropoulos¹  Achilles Anagnostopoulos¹  Ioanna Sakellari¹  Thomas Chatzikonstantinou¹  Despina Mallouri¹  Ioannis Batsis¹  Eleni Katsifa²  Stergios Papadimitriou¹  Alkistis Panteliadou¹  Eirini Baldoumi¹ 

[1] Hematology Department - BMT Unit, G. Papanicolaou Hospital;Microbiology Department, G. Papanicolaou Hospital

关键词: Klebsiella pneumoniae;    allogeneic hematopoietic cell transplantation;    graft-vs.-host disease;    treatment-related mortality;    overall survival;   

DOI  :  10.3389/fmed.2020.608165

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

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.

【 授权许可】

CC BY