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Infections

Control of infectious mortality due to carbapenemase-producing Klebsiella pneumoniae in hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 52, pages 114–119 (2017)Cite this article

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Abstract

Carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infections are an emerging cause of death after hematopoietic stem cell transplantation (HSCT). In allogeneic transplants, mortality rate may rise up to 60%. We retrospectively evaluated 540 patients receiving a transplant from an auto- or an allogeneic source between January 2011 and October 2015. After an Institutional increase in the prevalence of KPC-Kp bloodstream infections (BSI) in June 2012, from July 2012, 366 consecutive patients received the following preventive measures: (i) weekly rectal swabs for surveillance; (ii) contact precautions in carriers (iii) early-targeted therapy in neutropenic febrile carriers. Molecular typing identified KPC-Kp clone ST512 as the main clone responsible for colonization, BSI and outbreaks. After the introduction of these preventive measures, the cumulative incidence of KPC-Kp BSI (P=0.01) and septic shocks (P=0.01) at 1 year after HSCT was significantly reduced. KPC-Kp infection-mortality dropped from 62.5% (pre-intervention) to 16.6% (post-intervention). Day 100 transplant-related mortality and KPC-Kp infection-related mortality after allogeneic HSCT were reduced from 22% to 10% (P=0.001) and from 4% to 1% (P=0.04), respectively. None of the pre-HSCT carriers was excluded from transplant. These results suggest that active surveillance, contact precautions and early-targeted therapies, may efficiently control KPC-Kp spread and related mortality even after allogeneic HSCT.

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Acknowledgements

Institutional funding has supported this work. The corresponding author had full access to all the data in the study and had the final responsibility for the decision to submit for publication.

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Authors and Affiliations

  1. Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy

    A Forcina, S Piemontese, C Soliman, R Greco, F Lorentino, F Giglio, C Messina, M Carrabba, M Bernardi, J Peccatori, C Corti & F Ciceri

  2. University Vita-Salute San Raffaele, Milan, Italy

    A Forcina, V Marasco, F Lorentino, M Clementi & F Ciceri

  3. Emerging Bacterial Pathogens Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    R Baldan & D M Cirillo

  4. Microbiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    P Cichero, N Mancini & M Clementi

  5. Innovative Immunotherapies Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    A Bondanza

  6. Experimental Hematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    M Noviello

  7. Infections Control Committee, IRCCS San Raffaele Scientific Institute, Milan, Italy

    M Moro, A Biancardi & P Nizzero

  8. Infectious Disease Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy

    P Scarpellini

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  1. A Forcina
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  2. R Baldan
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  7. S Piemontese
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  10. F Lorentino
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  11. F Giglio
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  15. J Peccatori
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  16. M Moro
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  22. C Corti
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  24. F Ciceri
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Correspondence to F Ciceri.

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Forcina, A., Baldan, R., Marasco, V. et al. Control of infectious mortality due to carbapenemase-producing Klebsiella pneumoniae in hematopoietic stem cell transplantation. Bone Marrow Transplant 52, 114–119 (2017). https://doi.org/10.1038/bmt.2016.234

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  • DOI: https://doi.org/10.1038/bmt.2016.234

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