Clinical characteristics and outcomes of liver transplant recipients with carbapenem resistant klebsiella pneumonia infection.

BACKGROUND

Carbapenem resistant klebsiella pneumoniae infection increased the mortality rate of liver transplant recipients. This study aims to provide more evidence for the clinical diagnosis and treatment of carbapenem resistant klebsiella pneumonia infection in liver transplant recipients.

METHODS

This study included liver transplant recipients who developed CRKP infections during the perioperative period from January 2019 to December 2024 at Beijing You'an Hospital. Statistical analysis was performed on their clinical and outcomes characteristics.

RESULTS

Among the 48 liver transplant recipients with CRKP infections, the 30 days mortality rate and the 90 days mortality rate after infection was 25%(12/48) and 31.25%(15/48). The mortality rates of patients with abdominal cavity infections were significantly higher than those of other patients (p < 0.05). The mortality rate of patients with mechanical ventilation and with septic shock during infection was higher (p < 0.05). Among the initial laboratory indicators after patient infection, there were significant differences in platelet (PLT), procalcitonin (PCT), total bilirubin (TBIL), creatinine (CR), and urea (UR) between the survival group and the death group (p < 0.05). Intra-abdominal infection (OR = 7.413, 95% CI: 1.218-45.136, p = 0.030) and septic shock (OR = 25.015, 95% CI: 4.128-151.594, p < 0.001) were both independent risk factors for 90-days mortality. The drug sensitivity results of CRKP strains from liver transplant recipients showed that the three drugs with the lowest resistance rates were ceftazidime-avibactam, polymyxin, and tigecycline. Different drugs and drug combinations did not cause differences in the all-cause mortality rates of patients after infection (p > 0.05). The risk of death in patients who received effective antibiotics within 48 hours was reduced by 54.3% (HR = 0.457, 95% CI: 0.163-1.285, p = 0.135), but due to the limited sample size, this result did not reach statistical significance.

CONCLUSION

Clinicians should remain vigilant for abdominal infections, promptly control the infection source, and recognize early signs of septic shock to initiate timely treatment-key measures to reduce mortality for liver transplant recipients with CRKP infection. Additionally, effective antibiotic therapy within 48 hours after sampling may confer a survival benefit.