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Control of infectious mortality due to carbapenemase-producing Klebsiella pneumoniae in hematopoietic stem cell transplantation
- Source :
- Bone marrow transplantation. 52(1)
- Publication Year :
- 2016
-
Abstract
- Carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infections are an emerging cause of death after hematopoietic stem cell transplantation (HSCT). In allogeneic transplants, mortality rate may rise up to 60%. We retrospectively evaluated 540 patients receiving a transplant from an auto- or an allogeneic source between January 2011 and October 2015. After an Institutional increase in the prevalence of KPC-Kp bloodstream infections (BSI) in June 2012, from July 2012, 366 consecutive patients received the following preventive measures: (i) weekly rectal swabs for surveillance; (ii) contact precautions in carriers (iii) early-targeted therapy in neutropenic febrile carriers. Molecular typing identified KPC-Kp clone ST512 as the main clone responsible for colonization, BSI and outbreaks. After the introduction of these preventive measures, the cumulative incidence of KPC-Kp BSI (P=0.01) and septic shocks (P=0.01) at 1 year after HSCT was significantly reduced. KPC-Kp infection-mortality dropped from 62.5% (pre-intervention) to 16.6% (post-intervention). Day 100 transplant-related mortality and KPC-Kp infection-related mortality after allogeneic HSCT were reduced from 22% to 10% (P=0.001) and from 4% to 1% (P=0.04), respectively. None of the pre-HSCT carriers was excluded from transplant. These results suggest that active surveillance, contact precautions and early-targeted therapies, may efficiently control KPC-Kp spread and related mortality even after allogeneic HSCT.
- Subjects :
- 0301 basic medicine
Adult
Male
medicine.medical_specialty
Adolescent
Klebsiella pneumoniae
medicine.medical_treatment
030106 microbiology
Hematopoietic stem cell transplantation
beta-Lactamases
03 medical and health sciences
Bacterial Proteins
Internal medicine
medicine
Humans
Cumulative incidence
Autografts
Cause of death
Aged
Transplantation
biology
business.industry
Mortality rate
Hematopoietic Stem Cell Transplantation
Outbreak
Hematology
Middle Aged
bacterial infections and mycoses
biology.organism_classification
medicine.disease
Allografts
Shock, Septic
Klebsiella Infections
Graft-versus-host disease
Hematologic Neoplasms
Immunology
Female
business
Follow-Up Studies
Subjects
Details
- ISSN :
- 14765365
- Volume :
- 52
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Bone marrow transplantation
- Accession number :
- edsair.doi.dedup.....6a34c21a34a8a1c4fd6cf348517f77a2