供肾灌洗液培养出耐碳青霉烯类肺炎克雷伯菌的防治策略

Abstract
Figure/Table
References
Related Citation (15)

Download: PDF (816 KB) HTML (1 KB)
Export: BibTeX | EndNote (RIS)

Abstract Objective To investigate ways to deal with Carbapenem-resistant Klebsiella pneumoniae (CRKP) in preservation fluids (PF).Methods The treatment processes and outcomes of 12 kidney transplant recipients with CRKP in PF detected between May 2020 and January 2021 were retrospectively analyzed.Results All the patients received quick treatment after CRKP tested positive in their PF. Four of the patients received extended infusion of meropenem combined with fosfomycin, 7 received extended infusion of ceftazidime-avibatam combined with amtriaxanthin or fosfomycin, and 1 received extended infusion of polymyxin combined with extended infusion of meropenem and fosfomycin. There was no obvious discomfort except one patient with a transient temperature increase, but the levels of leukocytes, neutrophils and procalcitonin increased among these patients. Of the 12 recipients, 4 cases were cultured as CRKP in PF, 1 case as Enterococcus faecium and treated with linezolid, and the rest were only positive in PF. No renal artery rupture, renal transplant resection or death occurred in these patients, and the serum creatinine levels ranged from 79.8 to 202.5 μmol/L at discharge.Conclusions CRKP in PF deserves more attention. Treatment regimens should vary according to drug sensitivity results and drug availability.

Key words： kidney transplant Carbapenem-resistant Klebsiella pneumoniae preservation fluids meropenem polymyxin ceftazidime-avibatam

Received: 11 March 2021

ZTFLH:

R453.2

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	HOU Wenjing
	WANG Qiang
	GUO Mingxing
	ZHANG Jian
	WEN Aiping
	LIN Jun

Cite this article:

HOU Wenjing,WANG Qiang,GUO Mingxing等. Treatment of carbapenem-resistant Klebsiella pneumoniae in preservation fluids for 12 recipients of kidney transplantation[J]. Med. J. Chin. Peop. Armed Poli. Forc., 2021, 32(9): 781-785.

URL:

http://journal08.magtechjournal.com/Jwk_wjyx/EN/ OR http://journal08.magtechjournal.com/Jwk_wjyx/EN/Y2021/V32/I9/781

[1]	The Chinese Medical Association. Report on organ transplantation developement in China (2015-2018)[EB/OL].[2020-05-14]. http://en.cma.org.cn/art/2020/5/14/art_688_34499.html.
[2]	复旦大学附属华山医院抗生素研究所. 2020年CHINET中国细菌耐药监测结果[EB/OL].[2021-02-22].http://www.chinets.com/Document.
[3]	Cai Y S, Xiao H, Zhang S,et al. Carbapenem-resistant Klebsiella pneumoniae infection causing rupture of graft artery in solid organ recipients[J]. Medicine, 2019, 98(45): e17878.
[4]	Wang Y, Lei H, Zhang Y,et al. Epidemiology of carbapenem-resistant Klebsiella pneumoniae bloodstream infections after renal transplantation from donation after cardiac death in a Chinese hospital: a case series analysis[J]. Antimicrob Resist Infect Control, 2018, 7(66):1-11.
[5]	Xu L, Sun X, Ma X.Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae[J]. Ann Clin Microbiol Antimicrob, 2017, 16(18): 1-12.
[6]	Oriol I, Sabe N, Càmara J,et al. The Impact of culturing the organ preservation fluid on solid organ transplantation: a prospective multicenter cohort study[J]. Open Forum Infect Dis, 2019, 6(6): 180.
[7]	Yu X, Wang R, Peng W,et al. Incidence, distribution and clinical relevance of microbial contamination of preservation solution in deceased kidney transplant recipients: a retrospective cohort study from China[J]. Clin Microbiol Infect, 2019, 25(5): 595-600.
[8]	郭琛,刘剑,纪建磊,等. 供肾保存液的培养结果分析及临床意义[J]. 中华器官移植杂志,2018, 39(10): 602-605.
[9]	谭亮,谢续标,彭龙开,等. 供肾灌注液培养微生物分布及治疗对策[J]. 中华器官移植杂志,2018, 39(3): 135-139.
[10]	刘炎忠,柏宏伟,钱叶勇,等. DCD时代肾移植术后耐碳青霉烯类肺炎克雷伯菌感染的治疗经验总结[J]. 器官移植,2020, 11(1): 76-81.
[11]	吴佳晋,李大伟,张明,等. 肾移植术后供肾来源耐碳青霉烯类肺炎克雷伯菌感染九例诊疗经验[J].中华器官移植杂志,2019, 40(6): 334-338.
[12]	朱兰,王志强,马科,等. 肾移植术后供肾来源CRKP感染13例成功防治的临床经验[J]. 中华器官移植杂志,2019, 40(6): 328-333.
[13]	吴佳晋,应亮,李大伟,等. 肾移植供体来源耐药肺炎克雷伯杆菌感染13例救治经验[J]. 实用器官移植电子杂志,2018, 6(1): 9-12.
[14]	Jacobs D M, Ditursi S, Ruh C,et al. Combination treatment with extended-infusion ceftazidime/avibactam for a KPC-3-producing Klebsiella pneumoniae bacteraemia in a kidney and pancreas transplant patient[J]. Int J Antimicrob Agents, 2016, 48(2):225-227.
[15]	Elnekidy W S, Mooty M Y,Attallah N,et al. Successful treatment of multidrug resistant Klebsiella pneumoniae using dual carbapenem regimen in immunocompromised patient[J]. IDCases, 2017, 9(6):53-55.
[16]	Cani E, Moussavi F, Ocheretyaner E,et al. Carbapenem-resistant Klebsiella pneumoniae vertebral osteomyelitis in a renal transplant recipient treated with ceftazidime-avibactam[J]. Transpl Infect Dis, 2018, 20(2): e12837.
[17]	中华医学会器官移植学分会. 器官移植术后耐药菌感染诊疗技术规范(2019版)[J]. 器官移植,2019, 10(4): 352-358.
[18]	Aguado J M, Silva J T, Fernández-ruiz M,et al. Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations[J]. Transplant Rev (Orlando), 2018, 32(1): 36-57.
[19]	Smibert O, Satlin M J, Nellore A,et al. Carbapenem-resistant enterobacteriaceae in solid organ transplantation: management principles[J]. CurrInfect Dis Rep, 2019, 21(7): 26-38.
[20]	Tamma P D, Aitken S L, Bonomo R A,et al. Infectious diseases society of america antimicrobial resistant treatment guidance: Gram-negative bacterial infections[J]. Clin Infect Dis, 2020, 72(7): 1478.
[21]	Corbel A, LadriEre M, Leberre N,et al. Microbiological epidemiology of preservation fluids in transplanted kidney: a nationwide retrospective observational study[J]. Clin Microbiol Infect, 2020, 26(4): 475-484.
[22]	Leberre N, Ladrière M, Corbel A,et al. Antibiotic therapy in case of positive cultures of kidney transplant preservation fluid: a nationwide survey of prescribing practices[J]. Eur J Clin Microbiol Infect Dis, 2020, 39(5): 915-921.
[23]	《β-内酰胺类抗生素/β-内酰胺酶抑制剂复方制剂临床应用专家共识》编写专家组. β-内酰胺类抗生素/β-内酰胺酶抑制剂复方制剂临床应用专家共识(2020年版)[J]. 中华医学杂志,2020, 100(10):738-747.
[24]	Bishara J, Goldberg E, Lev S,et al. The utilization of solid organs for transplantation in the setting of infection with multidrug-resistant organisms: an expert opinion[J]. Clin Transplant, 2012, 26(6): 811-815.
[25]	Magiorakos A P, Srinivasan A, Carey R B,et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance[J]. Clin Microbiol Infect, 2012, 18(3): 268-281.
[26]	隋明星,赵闻雨. 美国移植协会《实体器官移植感染疾病诊疗指南》2013年第3版介绍(续二)实体器官移植中供体来源的感染[J]. 实用器官移植电子杂志,2014, 2(5): 266-270.