Clinical Features and Outcomes in ESBL-Producing Microorganisms in Renal Transplant Recipients with Urinary Tract Infections

Abstract

Multidrug-resistant organisms have become an increasing challenge in the management of both solid and non-solid organ transplants. This is especially true with extended spectrum beta-lactamases (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE) infections. We performed a retrospective study of 62 renal transplant recipients at a tertiary care center in El Paso, Texas. In our study population, 43% of patients had a positive urine culture and were treated for a UTI. 30% of those UTIs were caused by an ESBLproducing organism. Of note, 43% of the patients who developed a UTI also had a recurrent episode. Notably, one patient had 25 recurrences of UTIs caused by ESBL producing E. coli. K. pneumoniae and E. coli were the most commonly cultured non-ESBL-producing bacteria (40.7%). E. coli was the most frequently cultured ESBL-producing bacteria (62.5%), while K. pneumoniae was the second most frequently cultured ESBL-producing bacteria (37.5%). There were three transplant rejections; two had ESBL UTIs and one had 11 recurrent UTIs prior to rejection. Diabetes, the length of ureteral stents, and higher troughs of immunosuppressant therapy were observed to be correlated with higher rates of UTIs in our patient population. Our findings are consistent with reports published in current literature regarding rates of UTIs among renal transplant recipients. Due to increasing prevalence of multi-drug resistant organisms and increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE), it becomes imperative for clinicians to include CRE in the differential diagnosis when evaluating renal transplant recipients with recurrent UTIs. More importantly, CRE must be considered when evaluating renal transplant recipients with recurrent UTIs caused by ESBL producing organisms.