Risk Factors and Outcomes of Acute Graft Pyelonephritis with Bacteremia Due to Multidrug-Resistant Gram-Negative Bacilli among Kidney Transplant Recipients

Abstract

Acute graft pyelonephritis (AGP) is the leading cause of bloodstream infection in kidney transplant (KT) recipients. The prevalence of urinary tract infections caused by multidrug-resistant (MDR) Gram-negative bacilli is increasing. This 14-year prospective observational study sought to determine the clinical characteristics, risk factors, and outcomes of AGP with bacteremia due to MDR Gram-negative bacilli. Overall, 278 episodes of AGP with bacteremia due to MDR Gram-negative and non-MDR Gram-negative bacilli were identified and compared in 214 KT recipients; MDR Gram-negative bacilli were the cause in 28.4%. Overall 30-day mortality was low (1.1%). Risk factors independently associated with AGP due to MDR Gram-negative bacilli were male sex (OR 3.08; 95%CI 1.60–5.93), previous episode of bacteremic AGP (OR 2.11, 95%CI 1.09–4.09), prior antibiotic therapy in the preceding month (OR 2.47, 95%CI 1.33–4.57), and nosocomial acquisition (OR 2.03, 95%CI 1.14–3.62). Forty-three percent of MDR Gram-negative episodes received inappropriate empirical antibiotic therapy. The risk factors identified in this study may help physicians when selecting empirical antibiotic treatment for AGP. Previous antibiotic use was the main modifiable factor. Its presence highlights the importance of avoiding unnecessary antibiotics in order to bring down the high rates of MDR Gram-negative bacilli infections in this population.

Risk factors and outcomes of bloodstream infection from a urinary source in kidney transplant recipients

“…However, we found that males were more likely to develop BSIU. This observation aligns with a similar finding reported by Sabe et al in their prospective observational study where male KTR were at higher risk of multidrug resistant graft pyelonephritis and bacteremia relative to female KTR 13 . These findings suggest that the anatomical differences contributing to greater bacteriuria risk in females may not translate to an increased risk of BSIU.…”

“…This observation aligns with a similar finding reported by Sabe et al in their prospective observational study where male KTR were at higher risk of multidrug resistant graft pyelonephritis and bacteremia relative to female KTR. 13 These findings suggest that the anatomical differences contributing to greater bacteriuria risk in females may not translate to an increased risk of BSIU. To further understand why males may be at greater risk for BSIU, we performed a multivariable subgroup analysis of male KTR with bacteriuria that included urological history.…”

Differences in the composition of the bacterial element of the urinary tract microbiome in patients undergoing dialysis and patients after kidney transplantation

“…The impact of UTI on distant graft function is not fully understood. The predominance of pathogenic Gram-negative bacteria in urobiome of patients after kidney transplantation, indicated in some reports, highlights the problem of UTIs in recipients (Sabé et al, 2022) and a negative impact of early or late UTIs on the functioning of the transplanted kidney has been confirmed (Rani et al, 2017;Fiorentino et al, 2019;Pesce et al, 2019).…”

Species Distribution, Typical Clinical Features and Risk Factors for Poor Prognosis of Super-Elderly Patients with Bloodstream Infection in China

“…Bloodstream infection (BSI) has a high mortality and the number of BSI has been increasing for various risk factors, such as the widely application of central venous catheter (CVC). [1][2][3] According to the report from the China Antimicrobial Surveillance Network (CHINET), the number of specimens of BSI in China had increased from 296,052 in 2018 to 325,016 in 2021 (the report from the China National Drug Resistance Monitoring Network, https://www.carss.cn/sys/ Htmls/dist/index.html#/distribution?type=specimens). Our previous research also reported that the episodes of BSI had increased from 2010 to 2019 in the hospital where this study was conducted.…”