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

A Forcina, R Baldan, V Marasco, Paola Cichero, A Bondanza, M Noviello, S Piemontese, C Soliman, R Greco, F Lorentino, Fabio Giglio, C Messina, M Carrabba, M Bernardi, J Peccatori, M Moro, A Biancardi, P Nizzero, Paolo Scarpellini, DM CirilloN Mancini, C Corti, M Clementi, F Ciceri

Research output: Contribution to journalArticle

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.Bone Marrow Transplantation advance online publication, 26 September 2016; doi:10.1038/bmt.2016.234. © 2016 Macmillan Publishers Limited, part of Springer Nature.
Original languageEnglish
Pages (from-to)114-119
Number of pages6
JournalBone Marrow Transplantation
Volume52
Issue number1
DOIs
Publication statusPublished - 2017

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    Forcina, A., Baldan, R., Marasco, V., Cichero, P., Bondanza, A., Noviello, M., Piemontese, S., Soliman, C., Greco, R., Lorentino, F., Giglio, F., Messina, C., Carrabba, M., Bernardi, M., Peccatori, J., Moro, M., Biancardi, A., Nizzero, P., Scarpellini, P., ... Ciceri, F. (2017). Control of infectious mortality due to carbapenemase-producing Klebsiella pneumoniae in hematopoietic stem cell transplantation. Bone Marrow Transplantation, 52(1), 114-119. https://doi.org/10.1038/bmt.2016.234