Management of carbapenem-resistant K. pneumoniae in allogenic stem cell transplant recipients: the Turin bundle

Carbapenem resistance has evolved rapidly since 2001 and the distribution of Carbapenemase-producing Klebsiella pneumoniae (CR-Kp) is currently a public health concern worldwide. In the haematological setting, especially in allogenic transplant, CR-KP infections were associated with a mortality up to 65%. Aim of this report is to describe the management of patients colonized by CR-Kp and undergoing allo-HSCT with a multiple-step intervention strategy: the "Turin bundle". Steps included oral gentamicin (GO) within 20 days before allo-HSCT, avoidance of levofloxacin prophylaxis during neutropenia, treatment of febrile neutropenia with tigecycline 100 mg bid and piperacillin-tazobactam at standard dosages and early appropriate combination therapy for patients with severe sepsis. In our small series all patients survived, no resistance to oral gentamicin was observed and 60% of patients had negative rectal swabs after transplant.