Sun-117 Increasing Antibiotic Resistance Among Renal Transplant Recipients With Uti - A Developing World Scenario

Abstract

Introduction: Urinary tract infection (UTI) is a common complication after kidney transplant,prevalence ranging from 35 to 79%,associated with graft loss and increased healthcare cost 1. Beta-lactam antibiotics are the most frequently prescribed antimicrobial in the United States and worldwide 2. Nowadays ESBL(Extended-spectrum beta-lactamases) producing organism has become a major cause of concern causing antibiotic resistance 3,4 Very little data is available for antibiotic resistance pattern in developing world & further studies are needed in this area.The aim of this study is to determine the incidence of UTI and causative organisms,antibiotic susceptibility and resistance pattern over last four years. Methods: This is a retrospective observational-single center study conducted at PSRI Hospital, New Delhi.Post renal transplant patients between January 2015-July 2018 who had symptomatic UTI and urine culture positive were taken as subjects.The minimum follow up period of 3 months post transplant was taken as inclusion criteria.All the patients after transplant received triple immmunosuppression which included Tacrolimus, Mycophenolate and Steroids according to center protocol.Urine culture was performed with manual semi-quantitative technique & further identification & antimicrobial susceptibility testing was done using VITEK2.0 compact (Biomerieux,France).Antibiotics were prescribed according to their sensitivity report. ESBL positive organisms were defined as resistance to 3rd generation cephalosporins including ceftazidime.The data was entered in MS EXCEL spreadsheet & analysis was done using SPSS version 21.0.Statistical tests applied are Chi-Square test & Kaplan-Meier survival analysis curve.p value of < 0.05 was considered statistically significant. Results: A total of 91 episodes of UTI were identified in 66 subjects out of 211 urine samples processed.Incidence of infections were more common in initial 3 months(41.7%) following transplant possibly due to higher immunosuppression during this period.Growth of Gram Negative in 87(95.60%) & Gram positive in 4(4.40%) patients with Escherichia coli(57.1%) being the commonest followed by Klebsiella pneumoniae(28.5%),Pseudomonas(6.5%),Enterococcus spp.(3.3%) and Enterobacter (1.1%)(Table 1).Incidence of ESBL positive infection increased from 19.23% in 2015 to 34.62% in 2018.Resistance to antibiotics increased over last four years Example Amikacin(from 23% to 43%),Levofloxacin(from 61% to 82%),Ceftazidime(from 18% to 21%) & Meropenem(from 28% to 51%)(Picture).Even resistance to higher antibiotics such as Colistin which was not there in 2015 but was present in 2018(10%)(Picture).Kaplan-Meier curve showed that Infection free survival rates were better in 2015(66%) when compared with 2018(57%)