Does the urinary tract infection caused by carbapenem‐resistant Gram‐negative bacilli impact the outcome of kidney transplant recipients?

Abstract

The incidence of urinary tract infection (UTI) after kidney transplantation (KT) caused by multidrug-resistant (MDR) bacteria is growing. The aim of this study was to analyze the impact of UTI caused by carbapenem-resistant Gram-negative bacteria (CR-GNB) in the survival of graft and recipients following KT. This was a retrospective cohort study involving patients who underwent KT between 2013 and 2016. Patients were followed since the day of the KT until loss of graft, death or end of the follow-up period (31th December 2016). The outcomes measured were UTI by MDR following KT and graft and patient survival. Analyses were performed using Cox regression; for the graft and patient survival analysis, we used a propensity score for UTI by CR-GNB to matching a control group. UTI was diagnosed in 178 (23.9%) of 781 patients, who developed 352 UTI episodes. 44.6% of the UTI cases were caused by MDR bacteria. Identified risk factors for UTI by MDR bacteria were DM, urologic disease as the cause of end-stage renal failure, insertion of ureteral stent, carbapenem use, and delayed graft function (DGF). Risk factors for death during the follow-up period were female gender, patients over 60 years old at the time of KT, DM, body mass index over 31.8, UTI caused by CR-GNB. In conclusion, UTIs caused by CR-GNB have great impact on patients' survival after KT.

Distribution and Antibiotic Susceptibility Pattern of Multidrug-Resistant Bacteria and Risk Factors Among Kidney Transplantation Recipients with Infections Over 13 Years: A Retrospective Study

“…Regarding risk factors associated with MDR bacterial infection, female, older age and diabetes mellitus were prevalent independent risk factors associated MDR bacterial infection. 1 , 43 , 44 In our survey, we proved that female gender was a risk factor for MDR bacterial infection while no relationship has been found either with diabetes mellitus or older age. This may due to the small number of diabetes mellitus recipients and patients over 60 years old rarely receive kidney transplant surgery in China.…”

“…Kidney transplantation (KT), as the only curable option of treatment for chronic kidney disease, is threatened by all kinds of infections since they can pose a risk of acute rejection, delayed graft function, endanger allograft and patients’ survival, and result in longer hospital duration. 1–4 Moreover, they accounts for approximately 18% to 23% of death after KT. 5 The vast majority of infections occur within 6 months after surgery, especially within the first month.…”

“… 7 , 8 The use of broad-spectrum antibiotics, antibiotic abuse and more potent immunosuppressive regimens as well as other risk factors may contribute to the increase. 1 , 9 KTR are highly vulnerable to the threat of MDR bacterial infections and face a three times higher recurrence risk compared to those infected with non-MDR infection. 10 , 11 …”

Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection in Solid Organ Transplant Recipients: A Single-Center, Retrospective Study

“…Similarly, Lübbert et al reported higher infection rates and excess mortality among patients admitted to the liver transplant unit during a CP-Kp outbreak in a German hospital [22]. In a large Brazilian cohort of over a thousand kidney transplant recipients, 2.1% of the patients had CP-Kp infections, which were associated with a BSI in 38.7% of the cases, including a significantly reduced survival rate and an association with a higher SOFA score at the time of diagnosis [23].…”

Caracterización de la infección urinaria y resistencia antimicrobiana en receptores de trasplante renal de un centro colombiano

“…IC 95%: 1,3-3,2, p: 0,001]; Ariza-Heredia y cols., 20 no encontraron diferencia significativa en la tasa de filtración glomerular estimada ni en el valor absoluto de creatinina sérica en receptores de TxR con ITU (p: 0,646), sin embargo, en la estimación de la tasa de filtración glomerular con iotalamato encontraron una reducción de 5,09% en pacientes receptores de TxR que sufrieron al menos un episodio de ITU (p: 0,044); Sing y cols., 21 no encontraron diferencia en la función renal de receptores de TxR con ITU (p: 0,38) ni en la proteinuria (p: 0,14) tras un mes de ocurrido el evento infeccioso; Pesce y cols 3 recientemente describieron la ITU recurrente como factor predictor independiente de la función del injerto renal [HR: 2,2. IC 95%: 1,3-3,5, p: 0,001] y por último, Pinheiro y cols 22 definieron a la ITU causada por gérmenes productores de carbapenemasas como factor asociado a aumento de la mortalidad del receptor de TxR (HR: 2,62, IC 95%: 1,37-5,00, p: 0,04) y a la disminución de la supervivencia del injerto renal (p:0,006).…”