RESUMO
Abstract: Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae is spreading globally and represents achallenge in infection control and treatment. Solid organtransplant (SOT) recipients are especially at risk for infection bymultidrug-resistant bacteria, and little is known about infectionwith KPC-producing organisms in this setting. The aim of thisstudy was to describe the clinical and microbiologic aspects ofKPC-producing K. pneumoniae infections in SOT recipients. AKPC-2-producing K. pneumoniae outbreak was identified in apublic teaching tertiary care hospital in Sao Paulo, Brazil, in June2009. During the outbreak, cases of KPC-2-producing K.pneumoniae infection in SOT recipients occurred between July2009 and February 2010; these cases were retrospectivelyreviewed. Overall, 12 episodes of infection with KPC-producingK. pneumoniae occurred in 2 heart, 4 liver, and 6 kidneytransplant recipients with incidence rates of 16.7%, 12.9%, and26.3% in heart, liver, and kidney transplantation, respectively.Infection occurred at a median time of 20 days aftertransplantation. Primary infection sites were as follows: 4 urinarytract infections, 4 bloodstream infections, 2 pneumonias, and 2surgical site infections. All patients except one had receivedantibiotics in the last 30 days, mostly piperacillin-tazobactam orglycopeptides. All strains exhibited susceptibility to amikacin andgentamicin. Patients were treated with tigecycline plus polymyxinB (3 cases), polymyxin B plus carbapenem (3 cases), polymyxin Balone (3 cases), or tigecycline plus imipenem (1 case). In 2 cases,patients received only carbapenem, and death occurred before thefinal culture result. The overall 30-day mortality rate was 42%. Inthis series of KPC-producing K. pneumoniae infection in SOTrecipients, the infection occurrence was high during aninstitutional outbreak and was potentially life threatening.
