Bloodstream infections by gram‐negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome

Tsikala‐Vafea, Maria; Basoulis, Dimitrios; Pavlopoulou, Ioanna; Darema, Maria; Deliolanis, John; Daikos, George L.; Boletis, John; Psichogiou, Mina

doi:10.1111/tid.13442

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…The finding that nearly one-third of the episodes of bacteremic AGP in KT recipients were due to MDR Gram-negative bacilli is a cause for concern. The incidence of UTIs due to MDR Gram-negative bacilli in KT recipients is increasing at an alarming pace worldwide, ranging from 1.3 to 5.8 in different reports [ 5 , 15 , 20 , 21 ]. A better understanding of the risk factors for MDR Gram-negative infections in KT recipients is essential in order to identify measures for reducing MDR Gram-negative bacilli infections and for targeting empirical antibiotic therapy.…”

Section: Discussionmentioning

confidence: 99%

“…The high incidence of MDR Gram-negative bacilli in nosocomial UTIs in the general population is well known [ 22 ]. In KT recipients, a higher incidence of UTIs due to MDR Gram-negative bacilli has been reported in nosocomial settings [ 20 , 25 , 26 ]. This finding emphasizes the importance of applying high-quality infection control programs, including reducing the duration of procedures and the use of invasive instrumentation, and introducing improvements in infection control practices [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous antibiotic use has been identified as a significant risk factor for MDR infections in SOT recipients [ 2 , 6 , 20 , 27 ]. In our study, prior antibiotic therapy was also independently associated with AGP with bacteremia due to MDR Gram-negative bacilli, and was the main modifiable risk factor.…”

Section: Discussionmentioning

confidence: 99%

“…Although BSIs have been associated with poor outcomes in SOT recipients [ 30 ], other studies have reported lower mortality related to BSIs in SOT recipients than in the general population [ 31 ]. Moreover, BSIs of urinary origins have lower mortality than other sources of bacteremia [ 20 , 32 ]. BSIs caused by MDR Gram-negative bacilli in SOT recipients have been associated with higher mortality rates, especially in cases of delayed appropriate antibiotic treatment [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

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

Sabé

Maristany

Tuells

et al. 2022

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Sabé

Maristany

Tuells

et al. 2022

JCM

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“…KTRs are a population at high risk for bloodstream diffusion and sepsis [141] (ex 40% higher rate of sepsis than the general population [142]), which also represent a significant morbidity and mortality cause [143].…”

Section: Sepsis In Kidney Transplanted Patientsmentioning

confidence: 99%

Bacterial and Viral Infection and Sepsis in Kidney Transplanted Patients

et al. 2022

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Kidney transplanted patients are a unique population with intrinsic susceptibility to viral and bacterial infections, mainly (but not exclusively) due to continuous immunosuppression. In this setting, infectious episodes remain among the most important causes of death, with different risks according to the degree of immunosuppression, time after transplantation, type of infection, and patient conditions. Prevention, early diagnosis, and appropriate therapy are the goals of infective management, taking into account that some specific characteristics of transplanted patients may cause a delay (the absence of fever or inflammatory symptoms, the negativity of serological tests commonly adopted for the general population, or the atypical anatomical presentation depending on the surgical site and graft implantation). This review considers the recent available findings of the most common viral and bacterial infection in kidney transplanted patients and explores risk factors and outcomes in septic evolution.

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Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

Walti

2022

Curr Infect Dis Rep

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Purpose of Review Without effective antimicrobials, patients cannot undergo transplant surgery safely or sustain immunosuppressive therapy. This review examines the burden of antimicrobial resistance in solid organ transplant recipients and identifies opportunities for antimicrobial stewardship. Recent Findings Antimicrobial resistance has been identified to be the leading cause of death globally. Multidrug-resistant pathogens are associated with significant morbidity and mortality in transplant recipients. Methicillin-resistant S. aureus affects liver and lung recipients, causing bacteremia, pneumonia, and surgical site infections. Vancomycin-resistant enterococci is a nosocomial pathogen primarily causing bacteremia in liver recipients. Multidrug-resistant Gram-negative pathogens present urgent and serious threats to transplant recipients. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly K. pneumoniae , are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. P. aeruginosa and A. baumannii continue to be critical threats. While there are new antimicrobial agents targeting resistant pathogens, judicious prescribing is crucial to minimize emerging resistance. The full implications of the COVID-19 global pandemic on antimicrobial resistance in transplant recipients remain to be understood. Currently, there are no established standards on the implementation of antimicrobial stewardship interventions, but strategies that leverage existing antimicrobial stewardship program structure while tailoring to the needs of transplant recipients may help to optimize antimicrobial use. Summary Clinicians caring for transplant recipients face unique challenges tackling emerging antimcirobial resistance. Coordinated antimicrobial stewardship interventions in collaboration with appropriate expertise in transplant and infectious diseases may mitigate against such threats.

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Bloodstream infections by gram‐negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome

Cited by 6 publications

References 22 publications

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

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

Bacterial and Viral Infection and Sepsis in Kidney Transplanted Patients

Challenges of Antimicrobial Resistance and Stewardship in Solid Organ Transplant Patients

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