Introduction: Carbapenemase-producing enterobacteriaceae (KPC) infection has become a world public health issue since its first detection in 1996. Intuitively, immunocompromised patients might be at higher risk. However, very little data is known about the impact of KPC infection among renal transplant recipients.

Objective: To describe the epidemiological characteristics and outcomes of nosocomial KPC infection in a single center kidney transplant program.

Methods: This retrospective cohort study analyzed data concerning all KPC infection episodes diagnosed between November 5th, 2009 (index case) and June 13th, 2012. Population at risk was all kidney transplant recipients admitted to the hospital during the periods of observation. KPC infection was defined according to universal guidelines and diagnosed by biochemical and molecular tests, following CLSI 2010 recommendations.

Results: All KPC infection fulfilled criteria for nosocomial diseases (acquired between 6 and 110 days post hospital admission). Overall incidence density was 1.1 case/100 person-day (42 episodes), and peak incidence rates were observed in May of each year (mean of 4 episodes/100 person-day). Mean age of this population was 50 ± 15 y, being 59% male, 25% diabetic, 89% recipients of first transplant, 82% from deceased donors with a DGF incidence of 54%. Mean time after transplantation at diagnosis was 41 months and 35% occurred during initial hospital admission. Mean in-hospital length of stay was 59 days.Invasive catheter was used in 73% of patients and 38% had been admitted to an intensive care unit within the previous 30 days. Klebsiella ssp was identified in 95%, and Enterobacter aerogenes in 5%. Source of infection was urinary tract in 55%, bloodstream in 28%, lower respiratory tract in 9% and surgical site in 7%. Bacteremia was present in 45%, septic shock in 35% and acute allograft failure occurred in 85% of patients. Polimyxin was the most frequent used antimicrobial (92% of cases), in monotherapy (17%) or in dual combination with tygeciclin (33%), carbapenems (17%), or aminoglicosides (5%). Attributed 30-day mortality rate was 40%. Graft loss occurred in 36% of the survivors.

Conclusion: KPC infection represents a real threat to kidney transplant recipients. It is associated to prolonged length of stay, requires frequent use of nephrotoxic antimicrobial drugs, has high mortality rates and is often associated to allograft loss.

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