Infections by carbapenem-resistant Klebsiella pneumoniae (CRKp) represent a challenging problem after SCT. A retrospective survey (January 2010 to July 2013) involving 52 Italian centers was performed to assess the epidemiology and the prognostic factors of CRKp infections in auto- and allo-SCT. Cases of CRKp infection were reported in 53.4% of centers. CRKp infections were documented in 25 auto-SCTs and 87 allo-SCTs, with an incidence of 0.4% (from 0.1% in 2010 to 0.7% in 2013) and 2% (from 0.4% in 2010 to 2.9% in 2013), respectively. A CRKp colonization documented before or after transplant was followed by an infection in 25.8% of auto-SCT and 39.2% of allo-SCT patients. The infection-related mortality rates were 16% and 64.4%, respectively. A pre-transplant CRKp infection (hazard ratio (HR) 0.33, 95% confidence intervals (CIs) 0.15-0.74; P=0.007) and a not CRKp-targeted first-line treatment (HR 2.67, 95% CI 1.43-4.99; P=0.002) were independent factors associated with an increased mortality in allo-SCT patients who developed a CRKp infection. Our study shows challenging findings of CRKp infections in SCT patients in Italy particularly after allo-SCT. The detection of carriers and the definition of early therapeutic strategies represent critical aspects of the management of CRKp infections after SCT.
Infections by carbapenem-resistant Klebsiella pneumoniae in SCT recipients: A nationwide retrospective survey from Italy / Girmenia, C; Rossolini, Gm; Piciocchi, A; Bertaina, A; Pisapia, G; Pastore, D; Sica, S; Severino, A; Cudillo, L; Ciceri, F1; Scimè, R; Lombardini, L; Viscoli, C; Rambaldi, A; Gruppo Italiano Trapianto Midollo Osseo, (GITMO); Frigeni, M; Rambaldi, A; Corti, C; Ciceri, F; Mometto, G; Annaloro, C; Casari, E; Castagna, L; Rossi, G; Cattaneo, C; Russo, D; Cancelli, V; Alessandrino, Ep; Ripamonti, F; Pavan, F; Rovelli, A; Pecoraro, Claudia; Busca, A; Carraro, F; Fagioli, F; Gallo, S; Caravelli, D; Gobbi, Md; Saglio, G; Castellino, C; Mordini, N; Gaidano, G; Nassi, L; Raimondi, R; Vespignani, M; Scattolin, Am; Panizzolo, Is; Cesaro, S; Candoni, A; Patriarca, F; Bacigalupo, A; Raiola, A; Castagnola, E; Lanino, E; Stanzani, M; Bandini, Giannella; Massaccesi, Eleonora; Prete, A; Bassi, S; Vallisa, D; Caramatti, C; Aversa, F; Zuffa, E; Guidi, S; Bosi, A; Tintori, V; Iori, Ap; Capria, S; Cudillo, L; Arcese, W; Dentamaro, T; Fabritiis, Pd; Anaclerico, B; Chierichini, A; Piedimonte, M; Ferrari, A; Marchesi, F; Mengarelli, A; Cerchiara, E; Tirindelli, Mc; Gaziev, J; Severino, A; Majolino, I; Chiusolo, P; Sica, S; Bertaina, A; Lucarelli, B; Massei, Ms; Carotti, A; Perruccio, K; Caniglia, Maria Luisa; Santarone, S; Bartolomeo, Pd; Mazzotta, S; Galieni, P; Olivieri, A; Rosa, Gd; Risitano, A; Delia, M; Specchia, G; Palazzo, G; Pisapia, G; Messina, G; Irrera, G; Angelucci, E; Baronciani, D; Vacca, Annalisa; Crescimanno, A; Musso, M; Scimè, R; Imbriani, A; Milone, G.. - In: BONE MARROW TRANSPLANTATION. - ISSN 0268-3369. - 50:2(2015), pp. 282-288. [10.1038/bmt.2014.231]