Infections by carbapenem-resistant Klebsiella pneumoniae in SCT recipients: a nationwide retrospective survey from Italy

C Girmenia, G M Rossolini, A Piciocchi, A Bertaina, G Pisapia, D Pastore, S Sica, A Severino, L Cudillo, F Ciceri, R Scimè, L Lombardini, C Viscoli, A Rambaldi, Gruppo Italiano Trapianto Midollo Osseo (GITMO), Gruppo Italiano Trapianto Midollo Osseo GITMO, Marco Frigeni, Alessandro Rambaldi, Consuelo Corti, Fabio Ciceri, Gabriella Mometto, Claudio Annaloro, Erminia Casari, Luca Castagna, Giuseppe Rossi, Chiara Cattaneo, Domenico Russo, Valeria Cancelli, Emilio Paolo Alessandrino, Francesco Ripamonti, Fabio Pavan, Attilio Rovelli, Clara Pecoraro, Alessandro Busca, Francesca Carraro, Franca Fagioli, Susanna Gallo, Daniele Caravelli, Marco De Gobbi, Giuseppe Saglio, Claudia Castellino, Nicola Mordini, Gianluca Gaidano, Luca Nassi, Roberto Raimondi, Michele Vespignani, Anna Maria Scattolin, Irene Sara Panizzolo, Simone Cesaro, Anna Candoni, Francesca Patriarca, Andrea Bacigalupo, Annamaria Raiola, Elio Castagnola, Edoardo Lanino, Marta Stanzani, Giuseppe Bandini, Erika Massaccesi, Arcangelo Prete, Simona Bassi, Daniele Vallisa, Cecilia Caramatti, Franco Aversa, Eliana Zuffa, Stefano Guidi, Alberto Bosi, Veronica Tintori, Anna Paola Iori, Saveria Capria, Laura Cudillo, William Arcese, Teresa Dentamaro, Paolo De Fabritiis, Barbara Anaclerico, Anna Chierichini, Monica Piedimonte, Antonella Ferrari, Francesco Marchesi, Andrea Mengarelli, Elisabetta Cerchiara, Maria Cristina Tirindelli, Javid Gaziev, Alessandro Severino, Ignazio Majolino, Patrizia Chiusolo, Simona Sica, Alice Bertaina, Barbarella Lucarelli, Maria Speranza Massei, Alessandra Carotti, Katia Perruccio, Maurizio Caniglia, Stella Santarone, Paolo Di Bartolomeo, Serena Mazzotta, Piero Galieni, Attilio Olivieri, Gennaro De Rosa, Antonio Risitano, Mario Delia, Giorgina Specchia, Giulia Palazzo, Giovanni Pisapia, Giuseppe Messina, Giuseppe Irrera, Emanuele Angelucci, Donatella Baronciani, Adriana Vacca, Alessandra Crescimanno, Maurizio Musso, Rosanna Scimè, Alida Imbriani, Giuseppe Milone, C Girmenia, G M Rossolini, A Piciocchi, A Bertaina, G Pisapia, D Pastore, S Sica, A Severino, L Cudillo, F Ciceri, R Scimè, L Lombardini, C Viscoli, A Rambaldi, Gruppo Italiano Trapianto Midollo Osseo (GITMO), Gruppo Italiano Trapianto Midollo Osseo GITMO, Marco Frigeni, Alessandro Rambaldi, Consuelo Corti, Fabio Ciceri, Gabriella Mometto, Claudio Annaloro, Erminia Casari, Luca Castagna, Giuseppe Rossi, Chiara Cattaneo, Domenico Russo, Valeria Cancelli, Emilio Paolo Alessandrino, Francesco Ripamonti, Fabio Pavan, Attilio Rovelli, Clara Pecoraro, Alessandro Busca, Francesca Carraro, Franca Fagioli, Susanna Gallo, Daniele Caravelli, Marco De Gobbi, Giuseppe Saglio, Claudia Castellino, Nicola Mordini, Gianluca Gaidano, Luca Nassi, Roberto Raimondi, Michele Vespignani, Anna Maria Scattolin, Irene Sara Panizzolo, Simone Cesaro, Anna Candoni, Francesca Patriarca, Andrea Bacigalupo, Annamaria Raiola, Elio Castagnola, Edoardo Lanino, Marta Stanzani, Giuseppe Bandini, Erika Massaccesi, Arcangelo Prete, Simona Bassi, Daniele Vallisa, Cecilia Caramatti, Franco Aversa, Eliana Zuffa, Stefano Guidi, Alberto Bosi, Veronica Tintori, Anna Paola Iori, Saveria Capria, Laura Cudillo, William Arcese, Teresa Dentamaro, Paolo De Fabritiis, Barbara Anaclerico, Anna Chierichini, Monica Piedimonte, Antonella Ferrari, Francesco Marchesi, Andrea Mengarelli, Elisabetta Cerchiara, Maria Cristina Tirindelli, Javid Gaziev, Alessandro Severino, Ignazio Majolino, Patrizia Chiusolo, Simona Sica, Alice Bertaina, Barbarella Lucarelli, Maria Speranza Massei, Alessandra Carotti, Katia Perruccio, Maurizio Caniglia, Stella Santarone, Paolo Di Bartolomeo, Serena Mazzotta, Piero Galieni, Attilio Olivieri, Gennaro De Rosa, Antonio Risitano, Mario Delia, Giorgina Specchia, Giulia Palazzo, Giovanni Pisapia, Giuseppe Messina, Giuseppe Irrera, Emanuele Angelucci, Donatella Baronciani, Adriana Vacca, Alessandra Crescimanno, Maurizio Musso, Rosanna Scimè, Alida Imbriani, Giuseppe Milone

Abstract

Infections by carbapenem-resistant Klebsiella pneumoniae (CRKp) represent a challenging problem after SCT. A retrospective survey (January 2010 to July 2013) involving 52 Italian centers was performed to assess the epidemiology and the prognostic factors of CRKp infections in auto- and allo-SCT. Cases of CRKp infection were reported in 53.4% of centers. CRKp infections were documented in 25 auto-SCTs and 87 allo-SCTs, with an incidence of 0.4% (from 0.1% in 2010 to 0.7% in 2013) and 2% (from 0.4% in 2010 to 2.9% in 2013), respectively. A CRKp colonization documented before or after transplant was followed by an infection in 25.8% of auto-SCT and 39.2% of allo-SCT patients. The infection-related mortality rates were 16% and 64.4%, respectively. A pre-transplant CRKp infection (hazard ratio (HR) 0.33, 95% confidence intervals (CIs) 0.15-0.74; P=0.007) and a not CRKp-targeted first-line treatment (HR 2.67, 95% CI 1.43-4.99; P=0.002) were independent factors associated with an increased mortality in allo-SCT patients who developed a CRKp infection. Our study shows challenging findings of CRKp infections in SCT patients in Italy particularly after allo-SCT. The detection of carriers and the definition of early therapeutic strategies represent critical aspects of the management of CRKp infections after SCT.

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Source: PubMed

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