Extended-Spectrum-Beta-Lactamase Producing Bacteria Related Urinary Tract Infection in Renal Transplant Recipients and Effect on Allograft Function

Abstract

BackgroundUrinary tract infection (UTI) is a well-recognized early complication in renal transplant recipients (RTR) and can have significant bearing on their outcome. The recent rise in incidence of extended spectrum beta lactamase (ESBL) producing bacteria causing UTI among RTR poses new and significant challenges in terms of management and outcome. Our aim is to analyze the effect of ESBL producing bacteria causing UTI in these patients and its impact on allograft function.MethodsWe reviewed the medical records of 147 RTR who were followed at a tertiary care hospital affiliated transplant center between January 2007 and May 2013 and noted five RTR who developed episodes of ESBL producing bacteria related UTI during follow up. Multiple patient characteristics including demographics, immunosuppression, recurrences, allograft function and outcome were analyzed.ResultsFive patients (3.4%) out of 147 had ESBL producing bacteria related UTI. We found all patients to be above 60 years of age, with three out of five being females, and all five patients had diabetes mellitus. We identified a total of 37 episodes of UTI among these five patients during this period. Two of these patients had elevated creatinine values during the episodes of UTI and three of them developed bacteremia. Of the five patients, four of them had a favorable outcome except for one patient who developed persistent allograft dysfunction.ConclusionRTR are at a higher risk for developing ESBL producing bacteria associated UTI. Early diagnosis along with appropriate and judicious use of antibiotics will ensure long term success in allograft and patient outcome.

Phenotypic and genotypic detection of extended spectrum β-lactamases among Escherichia coli and Klebsiella pneumoniae isolates from type 2 diabetic patients with urinary tract infections

“…In the present study, ESBLs production appeared as a significant risk factor for acute kidney injury, where all patients with history of AKI had ESBL-UTIs (100%). Same finding were reported by Rahim et al (2018) from Bangladesh 20 and Ramadas et al (2014) from New York 28 . The results of antimicrobial susceptibility revealed that E. coli showed high resistance percentages to ampicillin (78.8%), followed by cefaclor (63.6%), norfloxacin (57.6%) and nitrofurantoin (54.6%).…”

Urinary Tract Infections in Kidney Transplant Patients Due to Escherichia coli and Klebsiella pneumoniae-Producing Extended-Spectrum β-Lactamases: Risk Factors and Molecular Epidemiology

“…Similar to Linares study [ 19 ] impairment of renal function, measured by delayed graft function, was risk factor for UTI due to ESBL-positive bacteria. The significant reduction of eGTF during UTI among KTPs [ 18 ] and high creatinine values [ 32 ] had already been reported by previous authors [ 18 ]. However, we demonstrated that such reduction is significantly higher among patients with UTI caused by ESBL-P bacteria probably due to the existence of acute kidney injury because of delayed graft function.…”

<p>Characterization of Extended-Spectrum β-Lactamase-Producing Uropathogenic <em>Escherichia coli</em> Among Iranian Kidney Transplant Patients</p>

“…A lower frequency of ESBL-positive isolates has been reported in France (10.9%), 24 Spain (25.7%), 1 Canada (10.7%), and the United States (3.4%). 25 A recent meta-analysis of the literature has reported that the incidence of the UTI caused by ESBL-producing Enterobacteriaceae in KTPs is 10%. 9 In accordance with our results, one study in northwestern of Iran reported that 40.6% of the UPEC isolates were ESBL producers.…”