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

• Published in: Transplantation proceedings Vol. 49; no. 8; pp. 1757 - 1765
• Main Authors: Brakemeier, S., Taxeidi, S.I., Zukunft, B., Schmidt, D., Gaedeke, J., Dürr, M., Hansen, S., Budde, K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2017
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; beta-Lactamases - urine; Case-Control Studies; Cohort Studies; Enterobacteriaceae - enzymology; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - etiology; Female; Glomerular Filtration Rate; Graft Survival; Hospitalization; Humans; Kaplan-Meier Estimate; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Male; Middle Aged; Prevalence; Recurrence; Renal Insufficiency - complications; Renal Insufficiency - mortality; Renal Insufficiency - surgery; Retrospective Studies; Risk Factors; Survival Analysis; Urinary Tract Infections - drug therapy; Urinary Tract Infections - etiology; Urinary Tract Infections - microbiology
• ISSN: 0041-1345; 1873-2623; 1873-2623
• DOI: 10.1016/j.transproceed.2017.06.033

Prevalence of extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E) has risen in kidney transplant (KT) patients, with no long-term data so far on graft function or survival. KT patients with ESBL-E–positive urine culture were retrospectively analyzed regarding initial adequate antimicrobial therapy, recurrent infection, transplant function, and survival compared with an ESBL-E–negative KT control cohort. ESBL-E–positive KT patients (n = 93) were older (55.5 ± 16.1 vs 49.5 ± 16.8 y; P = .001), presented with higher trough levels of cyclosporine and tacrolimus (121 ± 71 vs 102 ± 32 ng/mL [P = .04]; and 7.9 ± 3.3 vs 7.0 ± 2.3 ng/mL [P = .04], respectively), higher dosages of mycophenolate (1,533 ± 670 vs 1,493 ± 436; P = .001), and more acute rejection episodes within 3 months before diagnosis (12.9% vs 0.8%; P < .0001) compared with control subjects (n = 591). Five-year patient survival was superior in control subjects compared with ESBL-E–positive patients (91.2% vs 83.5%; P = .034) but long-term graft function was similar. Hospitalization rates were higher in patients presenting with ESBL-E–related urinary tract infection (UTI) compared with control subjects with ESBL-E–negative UTI (60.3% vs 31.3%; P = .002) but 5-year graft survival was superior in patients presenting with ESBL-E–related UTI (88.6% vs 69.8%; P = .035) compared with control subjects with ESBL-E–negative UTI. Recurrence rates were similar in patients with or without ESBL-E–related UTI. Initial antibiotic treatment was adequate in 41.2% of patients presenting with ESBL-E–related urosepsis, resulting in a reevaluation of antibiotic stewardship in our clinic. ESBL-E detection in general was associated with higher mortality, but graft survival in patients with ESBL-E–related UTI was significantly better compared with ESBL-E–negative UTI. •Long-term follow-up data on ESBL-E–positive KT patients in a low-prevalence cohort.•Risk factors for ESBL-E–positive UTI in KT patients: antirejection therapy, hospitalization, antibiotic treatment.•ESBL-E is associated with higher mortality in KT patients.•Antibiotic stewardship should focus on unit-based analysis of antimicrobiologic resistance data.