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.
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.
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.
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.
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.
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.
2021, Vol. 32 
