Klebsiella pneumoniae

DONOR: 21-year-old male with multiple injuries from a motor vehicle accident. He developed pneumonia, an infected subdural hematoma and meningitis due to carbapenemase-producing K.pneumoniae (CR-KP). Blood cultures were negative. He received treatment with tigecycline for 9 days and 3 doses of intrathecal gentamicin, but cultures were still positive 2 days before his demise. RECIPIENTS: LIVER/KIDNEY 1: the recipient developed intrabdominal infection with CR-KP. After 4 weeks of antibiotics, the infection cleared and the patient recovered. HEART: 69-year-old man with non ischemic cardiomyopathy. He received prophylaxis with cefepime and tigecycline with first doses started before transplantation and continued until 72 hrs after heart transplantation. Culture of thrombus from the donor heart was negative. The patient was discharged without infection on POD+9. He presented on POD+16 with mediastinits due to Candida albicans, all other cultures were negative. No transmission was documented from the donor (IWDT). KIDNEY 2: surgical prophylaxis with single dose gentamicin and tigecycline, and continued with tigecycline for 10 days, no transmission occurred (IWDT). VEIN GRAFT: used as anastomosis for liver transplant from a different donor, culture of the preservative fluid positive for CR-KP. Patient (recipient of living-donor liver transplantation, vein graft used for anastomosis between iliac vein of recipient and portal vein of the graft) received perioperative prophylaxis with tigecycline and amikacin, continued with 7 days of amikacin and 14 days of tigecycline. No transmission occurred (follow up 5 months, IWDT).