Objective Donor-derived carbapenem-resistant Klebsiella pneumoniae(CRKP)infection has recently emerged as a critical early complication after renal transplantation.Although CRKP is usually sensitive to tigecycline,mon...Objective Donor-derived carbapenem-resistant Klebsiella pneumoniae(CRKP)infection has recently emerged as a critical early complication after renal transplantation.Although CRKP is usually sensitive to tigecycline,monotherapy with this drug is often less than effective.We investigated the efficacy of a combined regimen of tigecycline with high-dose,extended-infusion meropenem in the treatment of donor-derived CRKP infection after kidney transplantation.Methods From Jan.2016 to Dec.2017,a total of 12 CRKP isolates were detected from cultures of the organ preservation solution used for soaking the donor kidneys at our institute.Probable or possible donor-derived infection(DDI)was identified in 8 transplant recipients.Clinical data were retrospectively analyzed.Results Klebsiella pneumoniae carbapenemase-2(KPC-2)-producing CRKP was reported to be positive in organ preservation solution cultures at 3.5±0.9 days after transplantation,leading to surgical site(n=3),urinary tract(n=4),and/or bloodstream(n=2)infections in 8 recipients.The drug susceptibility tests showed that CRKP was sensitive to tigecycline,but resistant to meropenem.In 7 patients who received tigecycline combined with high-dose extended-infusion meropenem,DDIs were successfully cured.The length of hospital stay was 31(18–129)days,and the serum creatinine at discharge was 105.8±16.7µmol/L.The one remaining patient who received tigecycline combined with intravenous-drip meropenem died of septic shock.A median follow-up of 43 months(33–55)showed no recurrence of new CRKP infection in the 7 surviving recipients.Conclusion It was suggested that a prompt and appropriate combination therapy using tigecycline with high-dose extended-infusion meropenem is effective in treating donor-derived KPC-2-producing CRKP infection after renal transplantation.展开更多
基金supported by grants from Non-Profit Central Research Institute Fund of Chinese Academy of Medical Science(No.2018PT32018)Hubei Science and Technology Plan(No.2017ACA096).
文摘Objective Donor-derived carbapenem-resistant Klebsiella pneumoniae(CRKP)infection has recently emerged as a critical early complication after renal transplantation.Although CRKP is usually sensitive to tigecycline,monotherapy with this drug is often less than effective.We investigated the efficacy of a combined regimen of tigecycline with high-dose,extended-infusion meropenem in the treatment of donor-derived CRKP infection after kidney transplantation.Methods From Jan.2016 to Dec.2017,a total of 12 CRKP isolates were detected from cultures of the organ preservation solution used for soaking the donor kidneys at our institute.Probable or possible donor-derived infection(DDI)was identified in 8 transplant recipients.Clinical data were retrospectively analyzed.Results Klebsiella pneumoniae carbapenemase-2(KPC-2)-producing CRKP was reported to be positive in organ preservation solution cultures at 3.5±0.9 days after transplantation,leading to surgical site(n=3),urinary tract(n=4),and/or bloodstream(n=2)infections in 8 recipients.The drug susceptibility tests showed that CRKP was sensitive to tigecycline,but resistant to meropenem.In 7 patients who received tigecycline combined with high-dose extended-infusion meropenem,DDIs were successfully cured.The length of hospital stay was 31(18–129)days,and the serum creatinine at discharge was 105.8±16.7µmol/L.The one remaining patient who received tigecycline combined with intravenous-drip meropenem died of septic shock.A median follow-up of 43 months(33–55)showed no recurrence of new CRKP infection in the 7 surviving recipients.Conclusion It was suggested that a prompt and appropriate combination therapy using tigecycline with high-dose extended-infusion meropenem is effective in treating donor-derived KPC-2-producing CRKP infection after renal transplantation.
文摘目的通过比较不同血小板输注策略的输注疗效,探讨血小板抗体筛查及交叉配型对于免疫性血小板输注无效(platelet transfusion refractoriness,PTR)患者的应用价值。方法采用固相凝集法对临床送检血小板抗体筛查的患者进行血小板抗体检测,提取患者的临床资料如性别、年龄、疾病种类、输血记录等,计算血小板抗体筛查阳性率并分析其分布特点。以血小板输注后增量(the post-transfusion platelet increment,PPI)和血小板校正后增值(the corrected count increment,CCI)为衡量指标,分析比较血小板抗体阳性以及不同输血策略(随机输注、交叉相合、交叉不相合)对患者血小板输注疗效的影响。结果血小板抗体筛查阳性患者61例(23.55%),且多为血液系统疾病患者;其中,抗体筛查阳性组的PPI(U=18851,P=0.0720)、CCI(U=14585,P=0.0183)、血小板输注有效率(χ^(2)=5.691,P=0.017)均低于抗体筛查阴性组。61例抗体阳性患者先后共输注122次血小板,其中,交叉相合73次,交叉不相合6次,随机输注43次;交叉相合组的PPI(11 vs 4,P<0.001)、CCI(6.7 vs 0,P=0.001)中位数均明显高于随机输注组(P<0.001),且血小板输注有效率高于随机输注组(58.6%vs 24.4%,χ^(2)=12.163,P=0.001)。对于血小板抗体阳性的血液病患者,交叉相合组的PPI(13.5 vs 0,P=0.025)、CCI(9.0 vs 0,P=0.001)中位数高于随机输注组,且血小板输注有效率高于随机输注组(60.7%vs 29.2%,χ^(2)=5.175,P=0.023)。交叉不相合组与其余两组之间的差异无统计学意义。结论临床有必要常规检测血小板抗体,且为患者提供交叉配血相合的血小板可以显著提高其血小板的输注疗效。
