Outcomes of Kidney Transplantation Using Organs From A Donor Infected with Carbapenem-Resistant Klebsiella Pneumoniae in A Chinese Hospital: A Molecular Epidemiological Study
Authors: Wang Yuxi , Jiang Ying , Li Peihan , Li Peng , Li Gang , Wang Zhen , Dong Chang , Liu Jingtao , Wang Jiaxing , Xu Cheng , Yu Jinggang , Gong Yichun , Wang Beilei , Liu Xiangdi , Liu Yingying , Deng Xianping , Mi Yunqiang , Wang Fang , Lei Hong , Zhang Yuxiang 
Published: July 2020

Abstract
Introduction: Although the high mortality rates and adverse events related to the post-operative infection have been extensively reported worldwide, to date, few studies have investigated the transmission of CRKP isolates between the Kidney Transplant Donors (KTDs) and Kidney Transplant Recipients (KTRs) with the aid of genetic and molecular study in mainland China. We sought to describe the antibiotic susceptibility, microbiological and clinical characteristics of CRKPs in donors and recipients admitted to our hospital, focusing on the clonal transmission between the donor and recipient in renal transplantation.Method: A retrospective analysis of clinical data of CRKP-BSIs in KTRs and the corresponding cadaveric donors admitted to a Chinese hospital in Beijing, China, between January 1, 2012 and December 31, 2017 was performed. The microbiology, clinical characteristics, antimicrobial susceptibility of both donors and recipients were analyzed. The genetic relatedness and sequencing type of the strains was determined by whole genome sequencing.Results: During the study period, there are total 297 KTRs from DCD performed in our hospital. Ten incidences of CRKP-BSIs in KTRs, and one CSKP-urinary tract infection in R3, were identified, and two of them (R1, R4) from the same foreign hospital. The incidence of CRKP-BSIs in the early stage (within 3 months) following kidney transplantation (KTx) from DCD was about 2.7% (8/297). Seven KTRs (R1-2, R4, R6-8, R10) associated with rupture of renal artery, occurring on the median 19th (16th-74th) day after KTx respectively, with the rate of rupture of renal artery of 63.6% (7/11), and in R4-5, the thrombus of renal transplant artery was presented on the 43th and 13th day after KTx respectively. Besides, Seven KTRs (R1-2, R4-5, R7-8, R10) underwent excision of transplanted graft on the median 19th(14th-43th) day after the KTx respectively in order to prevention of the further spread of CRKP to the remaining vital organs. Genomic analysis showed there existed two sequence types, ST290 strains and ST11, which fell into two separate clusters, with resistant genes including NDM, KPC and other carbapenemases genes identified. The blaNDM−1 gene was only detected in the ST290 isolates, while the blaKPC−1 gene detected in most isolates. Few SNPs were identified in isolates from donors and recipients.Conclusions: The CRKP positive result of various cultures from DCD donors can contribute to the transmission of infection to the recipients. It is mandatory to perform pre-donation screening for CRKP colonization whether or not the result of culture, not excluding the possibility of false negativity, and, if positive, donation should be contraindicated. The effective infection control strategy was the application of combinational antibiotic scheme including ceftazidime-avibactam plus carbapenem, in conjunction with source control techniques such as allograft nephrectomy and/or thorough debridement.