Epidemiology,Risk Factors,and Outcome of Bloodstream Infection Within the First Year After Kidney Transplantation |
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Authors: | Napadol Siritip Arkom Nongnuch Thanate Dajsakdipon Charat Thongprayoon Wisit Cheungprasitporn Jackrapong Bruminhent |
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Institution: | 1. Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;2. Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;3. Excellence Center of Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand;4. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States;5. Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, MS, United States;6. Division of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand |
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Abstract: | BackgroundMulti-drug resistant organisms have been emerging among kidney transplant (KT) recipients with bloodstream infections (BSI). The investigation for epidemiology, risk factors and outcome of these infections following KT was initiated.Materials and MethodsA retrospective study of all adult KT recipients who developed a BSI within the first year after KT in 2016 at a single transplant center was conducted. The cumulative incidence of BSI was estimated with Kaplan-Meier methodology. Clinical characteristics and outcome were extracted. Risk factors were analyzed with Cox proportional hazards models.ResultsAmong 171 KT recipients, there were 26 (15.2%) episodes of BSI. Fifty-nine percent were men and the mean ± SD age was 43 ± 12 years. The cumulative incidence of BSIs was 10.1% at 1 month, 13.5% at 6 months, and 15.2% at 12 months. Gram-negative bacteria were responsible for 92% of BSIs, Escherichia coli was the most common pathogen (65%) followed by Klebsiella pneumoniae (11%). Among those, 71% were resistant to extended-spectrum cephalosporins. The genitourinary tracts were the predominant source of BSIs (85%). The second kidney transplantation (HR, 4.55; 95% CI, 1.24–16.79 P = 0.02]) and receiving induction therapy (HR, 3.05; 95% CI, 1.15‐8.10 P < 0.03]) were associated with BSI in a multivariate analysis. One patient (4%) developed allograft rejection, allograft failure and death from septic shock.ConclusionsOne out of six KT recipients could develop BSI from gram-negative bacteria within the first year after transplant, particularly in those that received the second transplantation or induction therapy. |
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Keywords: | Corresponding author: Jackrapong Bruminhent MD Division of Infectious Diseases Department of Medicine and the Excellence Center of Organ Transplantation Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand Bacteremia Renal transplantation Extended-spectrum beta-lactamases Urosepsis Enterobacteriaceae Induction therapy |
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