MO156: The Choice of Empiric Antimicrobial Agent and its Association with Outcomes in Kidney Transplant Recipients with Urinary Sepsis

Abstract

BACKGROUND AND AIMS Efficient antibiotic therapy remains the cornerstone of successful sepsis treatment. Urinary sepsis, which remains the most common sepsis type in kidney transplant recipients (KTRs), is characterized by high prevalence of multidrug-resistant (MDR) bacterial strains, often limiting the choice of antimicrobial agents. The primary aim of this study was to elucidate the efficiency of primary empiric antimicrobial therapy in KTRs hospitalized for urosepsis, depending on the antibiotic choice. METHOD All primary urosepsis cases in KTRs hospitalized in 2014–2019 in the Transplantation Department of the Wroclaw Medical University Hospital were included retrospectively as the study group (n = 101). A total of 100 random KTRs hospitalized for primary urinary tract infection (UTI) were set as control group. The primary endpoint was the need for antibiotic change after 3 days of completed empiric treatment (due to lacking clinical response or proven antibiotic resistance). All patients were treated according to SSC guidelines with delay in antibiotic administration of no more than 1 h after the diagnosis of sepsis. RESULTS In the urosepsis and UTI groups, the need for antibiotic change after 3 days of treatment equaled 45.6% and 11%, respectively. Patients with urosepsis and inappropriate antibiotic therapy were at increased risk of death (OR = 10.1 with P = .021), need for acute renal replacement therapy (OR = 4.73 with P = .012) and non-recovery from AKI (OR = 3.18 with P = .031). Similar but not statistically significant trend was observed in the UTI group for lacking recovery from AKI (OR = 1.64 with P = .636). In both groups, the length of hospital stay was significantly longer in patients who did not receive appropriate empiric antimicrobial drug. Following antimicrobial agents were associated with appropriate successful treatment rates in the urosepsis and UTI groups: ciprofloxacine (0% versus 63%), amoxiciline with clavulonic acid (16.7% versus 89%), piperaciline with tazobactam (57% versus 60%), cefuroxime (67% versus 100%), third generation cephalosporines (76% versus 92%) and carbapenemes (100% versus 100%). CONCLUSION A delay in successful antibiotic therapy, caused by inappropriate choice of antimicrobial agents, for the treatment of urosepsis in KTRs is associated with detrimental kidney graft outcomes. Ciprofloxacine and amoxiciline with clavulonic acid should not be used for empiric therapy of urosepsis in this patient cohort. The development of urosepsis in KTRs as compared to non-septic UTI is associated with greater risk of antibiotic resistance among causative microorganisms and increased risk of antimicrobial failure.