Clinical Significance of Gastrointestinal Carriage of  Klebsiella Pneumoniae -Producing Extended-Spectrum Beta-Lactamases in Kidney Graft Recipients

Wilkowski, P.; Gajko, Kacper; Marczak, Maria; Hryniewiecka, Ewa; Wójtowicz, Monika; Dobrzaniecka, K.; Młynarczyk, G.; Pączek, Leszek; Ciszek, Michał

doi:10.1016/j.transproceed.2018.03.114

Cited by 9 publications

(16 citation statements)

References 15 publications

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“…The presented RTR had several factors that contributed to UTI risk, including immunosuppressive treatment, diabetes mellitus, and placement of a urinary catheter. Rectal carriage of ESBL+ K. pneumoniae is associated with UTIs in RTRs [5], supporting the assumption that intestinal colonisation with ESBL+ K. pneumoniae is a predisposing factor for UTIs in RTRs.…”

Section: Discussionmentioning

confidence: 73%

“…Infectious complications following renal transplantation (RTX) may worsen graft function and are associated with prolonged hospitalisation and increased medication costs, morbidity, and mortality [1, 3]. Urinary tract infection (UTI) is the most common bacterial infection after RTX [1, 2, 3, 4, 5]. Urinary isolates from RTRs have revealed a significant increase in antibiotic resistance rates, particularly with Klebsiella pneumoniae [4].…”

Section: Introductionmentioning

confidence: 99%

“…Urinary isolates from RTRs have revealed a significant increase in antibiotic resistance rates, particularly with Klebsiella pneumoniae [4]. The burden of UTIs caused by K. pneumoniae that produce extended-spectrum beta-lactamase (ESBL+) after RTX is an emerging problem [4, 5, 6]. Compatible with the possibility of conversion of intestinal carriage into active UTI, a strong association between gut ESBL+ K. pneumoniae colonisation and ESBL+ K. pneumoniae UTIs in RTRs has been demonstrated [5].…”

Section: Introductionmentioning

confidence: 99%

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Faecal Microbiota Transplantation Eradicated Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae from a Renal Transplant Recipient with Recurrent Urinary Tract Infections

Grosen

Povlsen

Lemming

et al. 2019

Case Rep Nephrol Dial

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Renal transplant recipients (RTRs) are highly susceptible to infections, and antimicrobial resistance is an increasing problem with limited treatment options. Faecal microbiota transplantation (FMT) is effective for recurrent Clostridium difficile infection and may be used for patients with intestinal carriage of multidrug-resistant (MDR) microorganisms. We present a RTR who suffered from recurrent urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase-producing (ESBL+) Klebsiella pneumoniae. Blood and urinary isolates revealed the same antibiotic susceptibility pattern, and whole-genome sequencing confirmed identical isolates in blood and urine. Despite several treatments with meropenem, the patient experienced recurrent infections that caused hospitalisation. ESBL+ K. pneumoniae was isolated in faeces. In an attempt to decolonise the gut, FMT was performed. A few days after nasojejunal infusion of donor faeces, the patient experienced a single relapse of UTI. During the subsequent 12 months, no further episodes of UTI occurred. Absence of ESBL+ K. pneumoniae in urine and faeces was demonstrated during follow-up. We conclude that FMT may be an effective treatment in RTRs with recurrent UTIs caused by intestinal colonisation with MDR organisms.

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Section: Discussionmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Faecal Microbiota Transplantation Eradicated Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae from a Renal Transplant Recipient with Recurrent Urinary Tract Infections

Grosen

Povlsen

Lemming

et al. 2019

Case Rep Nephrol Dial

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“…They also reported that 75% of ESBL UTIs had a prior history of a UTI with antibiotic treatment. 16 In our study, we found that 7 out of 17 patients had recurrent UTIs with ESBL-producing organisms. Among those patients, three patients had repeated cultures that were consistently positive only for ESBL-producing organisms.…”

Section: Discussionmentioning

confidence: 51%

“…The lower digestive tract of colonized patients is recognized as the primary source of ESBL-producing organisms. Wilkowski et al performed a study that showed a robust association between Klebsiella pneumoniae gut colonization and ESBL Klebsiella pneumoniae positive UTI in recipients of renal transplants (16). Factors that facilitate the spread of ESBL include its relative ease of emergence, diversity of parental beta-lactamases, and the mobility of ESBL genes (10).…”

Section: Discussionmentioning

confidence: 99%

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

Singh¹,

Jesus²,

Cooper³

et al. 2019

Int J Infect

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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.

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The impact of colonization by multidrug resistant bacteria on graft survival, risk of infection, and mortality in recipients of solid organ transplant: systematic review and meta-analysis

Almohaya,

Fersovich,

Weyant

et al. 2024

Clinical Microbiology and Infection

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Clinical Significance of Gastrointestinal Carriage of Klebsiella Pneumoniae -Producing Extended-Spectrum Beta-Lactamases in Kidney Graft Recipients

Cited by 9 publications

References 15 publications

Faecal Microbiota Transplantation Eradicated Extended-Spectrum Beta-Lactamase-Producing <b><i>Klebsiella pneumoniae</i></b> from a Renal Transplant Recipient with Recurrent Urinary Tract Infections

Faecal Microbiota Transplantation Eradicated Extended-Spectrum Beta-Lactamase-Producing <b><i>Klebsiella pneumoniae</i></b> from a Renal Transplant Recipient with Recurrent Urinary Tract Infections

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

The impact of colonization by multidrug resistant bacteria on graft survival, risk of infection, and mortality in recipients of solid organ transplant: systematic review and meta-analysis

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