Risk Factors and Outcomes of Klebsiella pneumoniae Infection Before and After Allogeneic Hematopoietic Cell Transplantation

Eleni Gavriilaki; Ioanna Sakellari; Thomas Chatzikonstantinou; Despina Mallouri; Ioannis Batsis; Eleni Katsifa; Stergios Papadimitriou; Alkistis Panteliadou; Eirini Baldoumi; Christos Demosthenous; Zoi Bousiou; Varnavas Constantinou; Damianos Sotiropoulos; Achilles Anagnostopoulos

doi:10.3389/fmed.2020.608165

Risk Factors and Outcomes of Klebsiella pneumoniae Infection Before and After Allogeneic Hematopoietic Cell Transplantation

Front Med (Lausanne). 2021 Feb 4:7:608165. doi: 10.3389/fmed.2020.608165. eCollection 2020.

Authors

Affiliations

¹ Hematology Department - BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece.
² Microbiology Department, G. Papanicolaou Hospital, Thessaloniki, Greece.

Abstract

Objectives: Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) emerge as a major healthcare concern worldwide. Despite the significance of infections before and after allogeneic hematopoietic cell transplantation (alloHCT), the burden of KP infections has not been extensively evaluated. Methods: We studied the incidence, risk factors, and outcomes of consecutive alloHCT recipients with Kp isolates before and after alloHCT. Results: Among 424 patients who underwent alloHCT in 2008-2018, we studied two groups: those with Kp isolates before (group 1, 52 patients) and those with Kp isolates after alloHCT (group 2, 66 patients). prE-transplant infections were associated with post-transplant infections (p = 0.010), despite secondary prophylaxis. KPC-Kp was isolated in 29% of group 1, and 80% of group 2. Both groups were characterized by a significant burden of moderate-severe acute graft- vs.-host disease (GVHD) [cumulative incidence (CI) of 44.5 and 61.9%, respectively] and severe chronic (CI of 56.7 and 61.9%). Kp infections and GVHD were independent predictive factors of treatment-related mortality (TRM) in both groups. Conclusions: Our study highlights the significant impact of Kp infections on TRM, with GVHD consisting an important underlying factor. As prophylactic measures did not improve rates of post-transplant infections, innovative interventions need to be further investigated to address this major healthcare concern.

Keywords: Klebsiella pneumoniae; allogeneic hematopoietic cell transplantation; graft-vs.-host disease; overall survival; treatment-related mortality.