Linares L, Cervera C, Hoyo I, Sanclemente G, Marco F, Cofán F, Ricart M J, Navasa M, Moreno A
Service of Infectious Diseases, Hospital Clinic, University of Barcelona, Barcelona, Spain.
Transplant Proc. 2010 Oct;42(8):2941-3. doi: 10.1016/j.transproceed.2010.07.080.
Klebsiella pneumoniae is a well recognized source of nosocomial infection in solid-organ transplant (SOT) recipients. It is also the most common species capable of producing extended-spectrum β-lactamases (ESBL). Its treatment can therefore be a challenge owing to antibiotic resistance.
Prospective study of all transplant recipients from July 2003 to December 2007 at our center. Klebsiellla pneumoniae infectious events were recorded.
A total of 1,057 patients were enrolled, 509 (48%) renal, 360 (34%) liver, 78 (7%) heart, and 110 (10%) double transplants. We diagnosed 116 episodes of K. pneumoniae infection in 92 patients during the study period, of which 62 were ESBL-producing strains (53%). Thirty-four episodes had bacteremia (29%), 15 of which were caused by ESBL-producing strains. There were no strains of K. pneumoniae producing carbapanemase (KPC). Forty-seven percent of the episodes occurred during the first month after transplantation. The incidence of infection by type of transplant was: renal 11%, liver 7%, cardiac 5%, and double transplant 6% (P=.075). The major sites of infection were urinary tract 72%, surgical wound 5%, intraabdominal 6%, catheter 5%, lung 1%, bloodstream 1%, and others 2%. ESBL-producing K. pneumoniae strains were more common in renal transplant patients (P=.035) and in those who required posttransplant dialysis (P=.022). There were 4 deaths in the first 30 days after the isolation of K. pneumoniae, and 3 of these cases were infections caused by ESBL-producing strains.
There was a high incidence of ESBL-producing K. pneumoniae infections in SOT recipients and renal transplant recipients, and those who required dialysis were more likely to develop infection by this strain. No KPC-producing organisms were found in our series. The existence of such a high level of resistance is a well recognized hospital threat, and appropriate policies and interventions should be addressed in high-risk patients.
肺炎克雷伯菌是实体器官移植（SOT）受者医院感染的一个公认来源。它也是最常见的能产生超广谱β-内酰胺酶（ESBL）的菌种。因此，由于抗生素耐药性，其治疗可能具有挑战性。
对2003年7月至2007年12月在我们中心的所有移植受者进行前瞻性研究。记录肺炎克雷伯菌感染事件。
共纳入1057例患者，其中肾移植509例（48%），肝移植360例（34%），心脏移植78例（7%），双器官移植110例（10%）。在研究期间，我们在92例患者中诊断出116例肺炎克雷伯菌感染，其中62例为产ESBL菌株（53%）。34例有菌血症（29%），其中15例由产ESBL菌株引起。未发现产碳青霉烯酶（KPC）的肺炎克雷伯菌菌株。47%的感染事件发生在移植后的第一个月。按移植类型划分的感染发生率为：肾移植11%，肝移植7%，心脏移植5%，双器官移植6%（P = 0.075）。主要感染部位为尿路72%，手术伤口5%，腹腔内6%，导管相关5%，肺部1%，血流1%，其他2%。产ESBL的肺炎克雷伯菌菌株在肾移植患者中更常见（P = 0.035），在需要移植后透析的患者中也更常见（P = 0.022）。在分离出肺炎克雷伯菌后的前30天内有4例死亡，其中3例是由产ESBL菌株引起的感染。
SOT受者和肾移植受者中产ESBL的肺炎克雷伯菌感染发生率较高，且需要透析的患者更易感染该菌株。在我们的系列研究中未发现产KPC的菌株。如此高水平的耐药性的存在是一个公认的医院威胁，应针对高危患者制定适当的政策和干预措施。
