De Rosa Francesco Giuseppe, Corcione Silvia, Raviolo Stefania, Bruno Benedetto, Busca Alessandro
Department of Medical Sciences, Infectious Diseases, University of Turin, Italy.
Department of Oncology, Allogenic Haematopoietic Stem Cell Transplant Unit, City of Health and Science of Turin, Molinette Hospital, University of Turin, Italy.
New Microbiol. 2017 Apr;40(2):143-145. Epub 2017 Apr 3.
Carbapenem resistance has evolved rapidly since 2001 and the distribution of Carbapenemase-producing Klebsiella pneumoniae (CR-Kp) is currently a public health concern worldwide. In the haematological setting, especially in allogenic transplant, CR-KP infections were associated with a mortality up to 65%. Aim of this report is to describe the management of patients colonized by CR-Kp and undergoing allo- HSCT with a multiple-step intervention strategy: the "Turin bundle". Steps included oral gentamicin (GO) within 20 days before allo-HSCT, avoidance of levofloxacin prophylaxis during neutropenia, treatment of febrile neutropenia with tigecycline 100 mg bid and piperacillin-tazobactam at standard dosages and early appropriate combination therapy for patients with severe sepsis. In our small series all patients survived, no resistance to oral gentamicin was observed and 60% of patients had negative rectal swabs after transplant.
