2300. Significance of Isolating Carbapenemase-producing Enterobacteriaceae in Liver and Liver Kidney Transplant
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Solid Organ Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • POSTER Id week KPC-Tx Final PDF.pdf (435.3 kB)
  • Background: There are few reports of infections produced by carbapenemase-producing Enterobacteriaceae (kpc) in solid organ transplants. Scarce available data, show higher mortality in these patients (p.). The objectives of this study are to evaluate risk factors for this infection and the evolution of p. with liver (LT) and liver-kidney (LKT) transplant, infected by Kpc, compared with uninfected LT or LKT p. To determine the frequency of infection in previously colonized patients.

    Methods: Clinical records of all p. who had received a LT or LKT between January 2010 and December 2015 were analyzed. Three controls were taken per patient with kpc infection, paired by gender, age, type of Tx and MELD score (Programm RStudio, propensity score): A total of 5 cases and 15 controls.

    Results: 228 transplants were performed in 224 p., 21 of these were retransplants and 13 were LKT. Presence of Kpc was detected in 10 p. (4.5% of p). Six episodes were considered colonization (C) (2.7%) and 8 episodes in five p. infection (I) (2.2% of p.). Patients infected by Kpc (cases): Gender (M/F): 2/3, Average age: 54 y. 1 p. LKT and 4 p. LT. Only one p. had a previous colonization. Infections were: 7 bacteraemia in 4 patients. Three of these were primary and four were secondary to hepatobiliar pathology. The mean of the length of stay in hospitalized patients the year before isolation in cases , was 55.6 days (d) and 26.8 d in controls (p=0.032). The mean of days receiving antibiotics in the three months previous to isolation was 45.2 in cases and 31.7 in controls (p=0.049). The average lenght of time receiving carbapenems was 14.6 for cases and 10.6 for controls (p=ns). In patients with I or C, mortality rate was 50% (5 of 10 p.), showing a difference between those who had C (40% mortality rate, 2 of 5 p.) and those who had I (60%, 3 of 5 p.). Mortality rate of controls was 2 of 15 (13%) (p=ns).

    Conclusion: Days of hospitalization and previous antimicrobials were confirmed as risk factors for this population. There was a trend of increased mortality in patients without Kpc (14%), colonized (40%) and infected with Kpc (60%). The difference was not statistically significant, probably due to the low number of patients.

    Noelia Mañez, MD infectious diseases fellow1, Astrid Smud, MD Infectious Diseases specialist1, Mariangeles Visus, Biochemical2, Ines Staneloni, MD Infectious diseases specialist1, Graciela Greco, Biochemical2, Alejandra Valledor, Infectious Diseases Specialist3 and Laura Barcan, MD infectious diseases specialist1, (1)Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, (2)Diagnostic, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina, (3)Internal Medicine, Hospital Italiano Buenos Aires, Buenos Aires, Argentina

    Disclosures:

    N. Mañez, None

    A. Smud, None

    M. Visus, None

    I. Staneloni, None

    G. Greco, None

    A. Valledor, None

    L. Barcan, None

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