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Alerting signals, symptoms, evidence of occurrence:
A critically ill 63 year old male received a kidney and liver transplant from a donor with KPC-producing Klebsiella pneumoniae meningitis infection. The recipient developed abdominal pain and tenderness with leukocytosis 10 days after surgery along with ascites and an enlarging perihepatic hematoma.
Demonstration of imputability or root cause:
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).
The correct reference citation is: Ariza-Heredia EJ, Patel R, Blumberg EA, Walker RC, Lewis R, Evans J, Sankar A, Willliams MD, Rogers J, Milano C, Razonable RR. Outcomes of transplantation using organs from a donor infected with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae. Transpl Infect Dis. 2012;14(3):229-36
Added information from the IWDT records ID 1472, 1473 and 1474 related to the other organs from the same reference ID 4306 (respectivelly for heart, kidney and vein recipients). RECORDS 1472, 1473 and 1474 WILL BE DELETED (EP, 2016-05-30).