Effect of Carbapenem-Resistant Klebsiella pneumoniae Infection on the Clinical Outcomes of Kidney Transplant Recipients

Figures & data

Table 1 Clinical Characteristics and Analysis of Risk Factors for CRKP Infection in 104 Renal Recipients with Early Infection

Patient Characteristics	CRKP Infected Group (n=16)	Non-CRKP Infected Group (n=88)	t-test^a/ Chi Square tEst^b/ Mann–Whitney U-test^c		Univariate Analysis		Multivariate Analysis
			t/Chi Square/U	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Median age, years, mean (standard deviation)	45.31 (13.40)	39.09 (12.91)	−1.742	0.085	1.039 (0.994–1.085)	0.088
Male, Sex, n (percentage)	15 (93.75%)	64 (72.72%)	3.277	0.070	5.625 (0.704–44.930)	0.103
Deceased donors, n (percentage)	15 (93.75%)	80 (90.90%)	0.138	0.710	1.500 (0.175–12.887)	0.712
Diabetes mellitus, n (percentage)	4 (25.00%)	14 (15.90%)	0.782	0.377	1.762 (0.496–6.259)	0.381
Hypertension, n (percentage)	16 (100%)	82 (93.18%)	1.158	0.282	-	0.999
Types of dialysis, n (percentage)
Hemodialysis	9 (56.25%)	74 (84.09%)	6.512	0.011	0.243 (0.078–0.761)	0.015	0.310 (0.039–2.467)	0.268
Peritoneal dialysis	5 (31.25%)	9 (10.23%)	5.136	0.023	3.990 (1.129–14.096)	0.032	2.410 (0.247–23.489)	0.449
None	2 (12.50%)	5 (5.68%)	1.003	0.317	2.371 (0.418–13.441)	0.329
Length of dialysis time, months, median (IQR)	12 (4, 18.5)	12 (6.25, 24)	1.085	0.280	0.979 (0.941–1.018)	0.279
Mean dosage of methylprednisolone, mg/kg, mean (standard deviation)	29.16 (6.32)	31.41 (9.34)	0.869	0.387	0.970 (0.904–1.039)	0.384
Anti-thymocyte globulin, n (percentage)	8 (50.00%)	32 (36.36%)	1.554	0.213	2.000 (0.663–6.029)	0.218
Mean dosage of anti-thymocyte globulin, mg/kg, median (IQR)	0 (0, 1.00)	0 (0, 1.34)	-	0.491	1.130 (0.647–1.975)	0.667
Basiliximab, n (percentage)	15 (93.75%)	77 (87.50%)	0.518	0.472	2.143 (0.257–17.862)	0.481
Sirolimus, n (percentage)	3 (18.75%)	15 (17.05%)	0.078	0.781	1.217 (0.306–4.845)	0.781
Delayed graft function, n (percentage)	5 (31.25%)	12 (13.64%)	3.072	0.080	2.879 (0.850–9.750)	0.089
Acute injection, n (percentage)	1 (6.25%)	4 (4.55%)	0.086	0.769	1.400 (0.146–13.405)	0.770
Possible donor derived infection, n (percentage)	5 (31.25%)	7 (7.96%)	7.198	0.007	5.260 (1.420–19.476)	0.013	6.743 (1.477–30.786)	0.014
Admission to ICU, n (percentage)	4 (25.00%)	6 (6.82%)	5.150	0.023	4.556 (1.120–18.524)	0.034	3.984 (0.742–21.408)	0.107
Multi-focal infections, n (percentage)	11 (68.75%)	22 (25.00%)	11.962	0.001
Multi-pathogen infections, n (percentage)	10 (62.50%)	25 (28.41%)	7.047	0.008
Types of infection, n (percentage)
Bloodstream infection	5 (31.25%)	13 (14.77%)	2.568	0.109
Surgical site infection	12 (75.00%)	50 (56.82%)	1.859	0.173
Urinary tract infection	11 (68.75%)	48 (54.54%)	1.113	0.291
Pneumonia	3 (18.75%)	7 (7.96%)	1.815	0.178
Unfavorable clinical outcomes, n (percentage)^c	9 (56.25%)	5 (5.68%)	29.718	<0.001
Recurrence after cure of infection	7 (43.75%)	5 (5.68%)	19.222	<0.001
Renal allograft loss	5 (31.25%)	1 (1.14%)	22.583	<0.001
Death	2 (12.50%)	1 (1.14%)	6.241	0.012

Notes: Data are presented in terms of mean±standard deviation, median and interquartile range (IQR) or the numbers of individuals with the percentage of the population. ^aComparison of the continuous variables in terms of mean±standard deviation were performed using two-sample t-test; ^bComparison of the categorical variables were performed using the chi-squared test; ^cComparison of the continuous variables in terms of median and IQR were performed using Mann–Whitney U-test.

Table 2 Clinical Features and Risk Factors Analysis for Patients with Unfavorable Clinical Outcomes in 104 Renal Recipients with Early Infection

Patient Characteristics	Unfavourable Outcomes (n=14)	Favourable Outcomes (n=90)	t-test^a/ Chi Square test^b/ Mann–Whitney U-test^c		Univariate Analysis		Multivariate Analysis
			t/Chi Square/U	P-value	OR (95% CI)	P-value	OR (95% CI)	P-value
Median age, years, mean (standard deviation)	40.43 (14.42)	39.99 (13.20)	−0.115	0.909	1.003 (0.961–1.046)	0.908
Male, Sex, n (percentage)	12 (85.71%)	67 (74.44%)	0.843	0.359	2.060 (0.428–9.901)	0.367
Deceased donors, n (percentage)	13 (92.86%)	82 (91.11%)	0.047	0.829	1.268 (0.146–10.993)	0.829
Diabetes mellitus, n (percentage)	2 (14.29%)	16 (17.78%)	0.103	0.748	0.771 (0.157–3.786)	0.749
Hypertension, n (percentage)	13 (92.86%)	85 (94.44%)	0.056	0.813	0.765 (0.083–7.076)	0.813
Types of dialysis, n (percentage)
Hemodialysis	9 (64.29%)	74 (82.22%)	2.419	0.120	0.389 (0.115–1.318)	0.129
Peritoneal dialysis	2 (14.29%)	12 (13.33%)	0.009	0.923	1.083 (0.215–5.450)	0.923
None	3 (21.43%)	4 (4.44%)	5.567	0.018	5.864 (1.157–29.724)	0.033
Length of dialysis time, months, median (IQR)	12 (5.5, 12.75)	12 (6, 24)	-	0.553	0.987 (0.953–1.022)	0.452
Mean dosage of methylprednisolone, mg/kg, mean (standard deviation)	30.82 (13.04)	31.14 (8.41)	0.116	0.908	0.996 (0.930–1.066)	0.907
Anti-thymocyte globulin, n (percentage)	7 (50.00%)	33 (36.67%)	1.411	0.235	2.015 (0.624–6.504)	0.241
Mean dosage of anti-thymocyte globulin, mg/kg, median (IQR)	0.42 (0, 1.10)	0 (0, 1.36)	-	0.346
Basiliximab, n (percentage)	12 (85.71%)	80 (88.89%)	0.120	0.729	0.750 (0.146–3.847)	0.730
Sirolimus, n (percentage)	3 (21.43%)	15 (16.67%)	0.324	0.569	1.500 (0.368–6.109)	0.571
Delayed graft function, n (percentage)	6 (42.86%)	11 (12.22%)	8.315	0.004	5.386 (1.571–18.468)	<0.01	1.000(0.119–8.418)	1.000
Acute injection, n (percentage)	1 (7.14%)	4 (4.44%)	0.193	0.661	1.654 (0.171–15.970)	0.664
Multi-focal infections, n (percentage)	12 (85.71%)	21 (23.33%)	21.764	<0.001	19.714 (4.083–95.199)	<0.001	1.173 (0.004–367.490)	0.957
Multi-pathogen infections, n (percentage)	11 (78.57%)	24 (26.67%)	14.618	<0.001	10.083 (2.590–39.263)	0.001	0.543 (0.002–132.797)	0.828
Types of infection, n (percentage)
Bloodstream infection	6 (42.86%)	12 (13.33%)	7.379	0.007	4.875 (1.438–16.522)	0.011	2.709 (0.295–24.865)	0.378
Surgical site infection	13 (92.86%)	49 (54.44%)	7.425	0.006	10.878(1.365–86.706)	0.024	15.588 (0.442–550.231)	0.131
Urinary tract infection	12 (85.71%)	47 (52.22%)	5.536	0.019	5.489 (1.162–25.942)	0.032	7.024 (0.234–211.036)	0.262
Pneumonia	5 (35.71%)	5 (5.56%)	12.680	<0.001	9.444 (2.289–38.966)	<0.01	28.458 (1.956–413.984)	0.014
Possible donor derived infection, n (percentage)^c	3 (21.43%)	9 (10.00%)	1.550	0.213	2.455 (0.575–10.469)	0.225
Admission to ICU, n (percentage)	4 (28.57%)	6 (6.67%)	6.689	0.010	5.600 (1.347–23.283)	0.018	1.938 (0.145–25.834)	0.617
CRKP infection	9 (64.29%)	7 (7.78%)	29.718	<0.001	21.343 (5.600–81.345)	<0.001	20.723 (3.448–124.547)	0.001

Notes: Data are presented in terms of mean±standard deviation, median and interquartile range (IQR) or the numbers of individuals with the percentage of the population. ^aComparison of the continuous variables in terms of mean±standard deviation were performed using two-sample t-test; ^bComparison of the continuous variables in terms of median and IQR were performed using Mann–Whitney U-test; ^cComparison of the categorical variables were performed using the chi-squared test.

Table 3 Clinical Characteristics and Antibiotic Regimens in 16 Renal Recipients with CRKP Infection

Patient Characteristics	Recurrence After Cure of Infection		t-test ^a/Chi Square test^b		Unfavourable Outcomes		T/Chi Square test
	Yes (n=7)	No (n=9)	t/Chi Square value	P-value	Yes (n=9)	No (n=7)	T/Chi Square value	P-value
Median age, years, mean (standard deviation)	41.43 (15.84)	48.33 (13.30)	0.948	0.359	43.22 (14.28)	48.00 (15.21)	0.646	0.529
Male, Sex, n (percentage)	6 (85.71%)	9 (100%)	1.371	0.242	8(88.89%)	7 (100%)	0.830	0.362
Deceased donors, n (percentage)	6 (85.71%)	9 (100%)	1.371	0.242	8(88.89%)	7 (100%)	0.830	0.362
Diabetes mellitus, n (percentage)	2 (28.57%)	2 (22.22%)	0.085	0.771	2 (22.22%)	2 (28.57%)	0.085	0.771
Hypertension, n (percentage)	7 (100%)	9 (100%)	-	-	9 (100.00%)	7 (100%)	-	-
Types of dialysis, n (percentage)
Hemodialysis	5 (71.43%)	4 (44.44%)	1.165	0.280	5 (55.56%)	4 (57.14%)	0.004	0.949
Peritoneal dialysis	1 (14.29%)	4 (44.44%)	1.667	0.197	2 (22.22%)	3 (42.86%)	0.780	0.377
None	1 (14.29%)	1 (11.11%)	0.036	0.849	2 (22.22%)	0 (0%)	1.778	0.182
Length of dialysis time, months, mean (standard deviation)	14.43 (16.94)	15.29 (8.73)	−0.119	0.907	13.50 (9.53)	16.67 (17.39)	0.438	0.669
Mean dosage of methylprednisolone, mg/kg, mean (standard deviation)	25.76 (7.67)	31.72 (3.84)	1.916	0.079	27.07 (7.82)	31.26 (3.90)	1.268	0.229
Anti-thymocyte globulin, n (percentage)	4 (57.14%)	4 (44.44%)	0.077	0.782	5 (55.56%)	3 (42.86%)	0.579	0447
Basiliximab, n (percentage)	6 (85.71%)	9 (100%)	1.371	0.242	8 (88.89%)	7 (100%)	0.830	0.362
Sirolimus, n (percentage)	1 (14.29%)	2 (22.22%)	0.069	0.792	1 (11.11%)	2 (28.57%)	0.603	0.438
Delayed graft function, n (percentage)	3 (42.86%)	2 (22.22%)	0.780	0.377	4 (44.44%)	1 (14.29%)	1.667	0.197
Acute injection, n (percentage)	1 (14.29%)	0 (0%)	1.371	0.242	1 (11.11%)	0 (0%)	0.830	0.362
Possible donor derived infection, n (percentage)	2 (28.57%)	3 (33.33%)	0.042	0.838	2 (22.22%)	3 (42.86%)	0.780	0.377
Admission to ICU, n (percentage)	3 (42.86%)	1 (11.11%)	2.116	0.146	4 (44.44%)	0 (0%)	4.148	0.042
Antibiotic regimen containing tigecycline and meropenem, n (percentage)	1 (14.29%)	3 (33.33%)	0.762	0.383	3 (33.33%)	1 (14.29%)	0.762	0.383
Antibiotic regimen containing polymyxin B, n (percentage)	3 (42.86%)	2 (22.22%)	0.780	0.377	4 (44.44%)	1 (14.29%)	1.667	0.197
Antibiotic regimen containing ceftazidime/avibactam, n (percentage)	0 (0%)	4 (44.44%)	4.148	0.042	0 (0%)	4 (57.14%)	6.857	0.009

Notes: Data are presented in terms of mean±standard deviation or the numbers of individuals with the percentage of the population. ^aComparison of the continuous variables in terms of mean±standard deviation were performed using two-sample t-test; ^bComparison of the categorical variables were performed using the chi-squared test.

Table 4 Correlation Analysis of Clinical Characteristics, Antibiotic Regimens, CRKP Infection and Unfavorable Clinical Outcomes in 104 Renal Recipients with Early Infection

Patient Characteristics	CRKP Infection		Unfavorable Clinical Outcomes
	r	P	r	p
Age	0.170	0.085	0.011	0.909
Sex	0.178	0.071	0.090	0.363
Multi-focal infections	0.339	<0.001	0.457	<0.001
Multi-pathogen infections	0.260	0.008	0.375	<0.001
Antibiotic regimen containing tigecycline and meropenem	-	-	0.218	0.417
Antibiotic regimen containing polymyxin B	-	-	0.323	0.223
Antibiotic regimen containing ceftazidime/avibactam			−0.655	0.006
CRKP infection	1	-	0.535	<0.001

Notes: Correlation analysis of the categorical variables were performed using Pearson correlation analysis.