Rectal swab screening for carbapenem-resistant Klebsiella pneumoniae bloodstream infections in liver transplant recipients: a retrospective cohort study.

BACKGROUND The incidence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection following liver transplantation (LT) has been increasing. The primary objective of this study was to investigate the utility of rectal swab screening for CRKP in this patient population.

METHODS We retrospectively collected rectal swab screening data from 472 liver transplant recipients between June 2018 and December 2023. Subsequently, we analyzed the risk factors associated with CRKP bloodstream infections (BSIs) and assessed the incidence of CRKP BSIs following an intervention involving a combination therapy of tigecycline and polymyxin.

RESULTS Among the 472 liver transplant recipients, 38 (8.1%) tested positive for CRKP in rectal swab screening. Univariate analysis identified severe hepatitis (P = 0.008), delayed recovery of transplanted liver function (P = 0.006), and the use of anti-human thymocyte immunoglobulin (P = 0.020) as significant risk factors for CRKP BSIs. The incidence of bloodstream infection was significantly lower in recipients who received the intervention treatment compared to those who did not (P = 0.021).

CONCLUSIONS Rectal swab screening in liver transplant recipients provides early warning for the development of CRKP BSIs. Early intervention in high-risk patients with positive rectal swab results may effectively reduce the incidence of CRKP BSIs.