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

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

JOURNAL=Frontiers in Medicine

VOLUME=7

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2020.608165

DOI=10.3389/fmed.2020.608165

ISSN=2296-858X

ABSTRACT=<p><bold>Objectives:</bold><italic>Klebsiella pneumoniae</italic> carbapenemase (KPC)–producing <italic>K. pneumoniae</italic> (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.</p><p><bold>Methods:</bold> We studied the incidence, risk factors, and outcomes of consecutive alloHCT recipients with Kp isolates before and after alloHCT.</p><p><bold>Results:</bold> 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 (<italic>p</italic> = 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.</p><p><bold>Conclusions:</bold> 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.</p>