Risk Factors for Infection with Extended-Spectrum and AmpC β-Lactamase-Producing Gram-Negative Rods in Renal Transplantation

Abstract

Increasing prevalence of infections caused by multiresistant gram-negative enteric bacilli due to synthesis of extended-spectrum b-lactamase (ESBL) or to desrepressed chromosomic AmpC b-lactamase (AmpC) is a major concern in the hospitalized patient population. Renal transplant recipients are especially susceptible to these infections. A cohort observational study in a 3-year period was performed. ESBL-production was determined by phenotypic analysis based on the CLSI recommendations. A multi-variate logistic regression analysis was performed to identify independent variables associated with multi-resistant gram-negative bacilli infection. The study included 417 patients (61 double kidney-pancreas recipients). The incidence of ESBL-producing and desrepressed chromosomic AmpC b-lactamase resistance was 11.8% (49 patients). The most frequent bacteria isolated was E. coli (35/60 isolations), followed by Klebsiella spp (12/60 isolations). Double kidney-pancreas transplantation (OR 3.5, CI95% 1.6-7.8), previous use of antibiotics (OR 2.1,CI95% 1.1-4.1), posttransplant dialysis requirement (OR 3.1, CI95% 1.5-6.4) and posttransplant urinary obstruction (OR 5.8, CI95% 2.2-14.9) were independent variables associated with these multiresistant gram-negative enteric bacilli infections. The incidence of ESBL-producing and desrepressed AmpC b-lactamase gram-negative enteric bacilli infection in our population was high. These infections are associated with significant morbidity after renal transplantation.

Beta-lactam and quinolone resistance markers in uropathogenic strains isolated from renal transplant recipients

“…: K. pneumoniae (14), P. aeruginosa (4), M. morganii (2), E. coli (1) and E. tarda (1). The findings of our study are in accordance with several other studies that are describing an elevated frequency of ESBL infections among RTRs that received prophylactic antibiotic treatment [20,21,4,22,23]. We found that all of them exhibited resistance to third generation cephalosporins, that it is reported to be linked to the emergence of MDR isolates [24].…”

Proteomic profiling of renal allograft rejection in serum using magnetic bead–based sample fractionation and MALDI-TOF MS

“…Humoral immunity attacks allografts by producing specific antibodies against the grafts [20][21][22][23][24]. In addition, pre-existing conditions, such as diabetes mellitus, [25,26], hypertension [27,28], cardiovascular conditions [29,30], infections [31][32][33], malignancy [34][35][36], were all factors that affect the outcomes and survival of transplant grafts. Once a pathological process begins, renal allografts express and release protein molecules at different levels or patterns compared with their physiological conditions.…”

Pretransplant Fecal Carriage of Extended-Spectrum β-Lactamase–producingEnterobacteriaceaeand Infection after Liver Transplant, France

“…Solid organ transplant has been shown to be a risk factor for nosocomial ESBLE bacteremia ( 6 ), but little research has been conducted to identify risk factors for ESBLE infections among these patients, and previous studies included only kidney transplant recipients ( 7 , 8 ). Liver transplant (LT) recipients are particularly at risk for bacterial infections because of the severity of illness associated with preoperative end-stage liver disease and the technical complexity of surgery ( 9 ).…”