Extended-Spectrum Beta-Lactamase–Producing Enterobacteriaceae –Related Urinary Tract Infection in Kidney Transplant Recipients: Risk Factors, Treatment, and Long-Term Outcome

Clinical Features and Outcomes in ESBL-Producing Microorganisms in Renal Transplant Recipients with Urinary Tract Infections

“…These studies demonstrate that the length of stent placement correlates with a higher prevalence of ESBL UTIs and a high rate of UTI recurrence even after stent removal. Immunosuppression with tacrolimus and prednisone were shown to correlate with higher rates of ESBL infections, and higher troughs of tacrolimus and mycophenolate were associated with higher rates of ESBL UTI (11,19,20). This reported data is consistent with observations from our collected data.…”

Multidrug-Resistant Organisms: Posttransplant Management for Extended-Spectrum Beta-Lactamase Producers and Carbapenem-Resistant Enterobacterales

“…In SOT recipients, the proportion of Enterobacterales that harbor ESBL enzymes in clinical blood samples fluctuates by region and local resistance patterns, ranging from 3% in the USA (although this estimate is from 2007) to 60% in China [5,[10][11][12][13]. Similarly, the risk of developing an ESBL-EB infection posttransplant varies by geography but ranges between 3.4 and 16.9% in abdominal organ transplant recipients (Table 1) [14][15][16][17][18][19][20][21]. The highest risk has been reported in Brazil, where 16.9% of kidney transplant patients at one hospital developed an ESBL-EB urinary tract infection (UTI) [15].…”

“…Bacteremia is most commonly secondary to a UTI, especially in kidney transplant patients, but can also be caused by catheter-associated infections and surgical site infections [14]. In one study analyzing Gram-negative bacteremia after SOT, the highest incidence of bacteremia was in the first month [13], although other studies have found that the mean or median time from transplant to ESBL-EB infection can vary significantly from 15 days to 52 months [14,18,[20][21][22].…”

“…The risk factors for developing an ESBL-EB infection following SOT include older age, increased immunosuppression, diabetes, posttransplant infection, reoperation or hemodialysis, graft rejection, hospitalization or antibiotic use in the last 6 months, pretransplant ESBL colonization, and a model for end-stage liver disease (MELD) score 25 in liver transplant patients [11,15,20,23]. Organ transplant itself has also been identified as a risk factor for ESBL E. coli bacteremia [24].…”

“…Infections due to ESBL-EB have been associated with increased morbidity and mortality among SOT recipients. The 30-day mortality rate for abdominal SOT recipients with ESBL-EB infections can be up to 26%, with the highest mortality reported in bacteremic patients (Table 1) [14,16,20,21]. In the context of lung transplantation, one small study in Israel identified five patients with definitive ESBL-producing K. pneumoniae infections, and all five died within 14 months of follow-up; the proportion of deaths attributable to the ESBL infection is unknown [22].…”