Background: Bloodstream infections or bacteremia is a serious complication after kidney transplantation. The incidence, risk factors, and outcomes of bacteremia among kidney transplant recipients have not been well characterized.

Methods: Patients receiving kidney transplants from 1-Jul-2004 to 1-Dec-2014 at the Toronto General Hospital, with follow-up to 31-Dec-2015, were eligible for study inclusion. Bacteremia was defined as two blood culture positives (separated by site or time) for common skin contaminants or one blood culture positive for other organisms (e.g., gram-negative species). The cumulative incidence of first bacteremia was estimated using the Kaplan-Meier product limit method. Risk factors for bacteremia were examined n a multivariable Cox proportional hazards model. The risk of graft failure or death, as a function of bacteremia, was assessed in a time-dependent Cox proportional hazards model.

Results: The study cohort included 1325 patients. The mean age was 50.4 years and 60.1% of the cohort was male. Diabetes mellitus was present in 28.5% and 73.5% were on hemodialysis prior to transplant. Over 5966 person-years of follow-up, 155 patients were observed to experience at least one bacteremia episode. The most common pathogens included coagulase negative Staphylococcus aureus (25.1%) and Escherichia coli (31.0%). The cumulative incidence of first bacteremia post-transplant was 6.8% at 6-months, 8.4% at 2-years and 11.9% at 5-years. Factors significantly associated with an increased risk of bacteremia included a recipient history of diabetes mellitus, median time on dialysis, dialysis modality, delayed graft function, donor age, and donor eGFR. First episode of bacteremia was associated with an increased risk of total graft failure (hazard ratio [HR] 2.35 [95% CI: 1.68, 3.29]), death-censored graft failure (HR 2.03 [95% CI: 1.16, 3.52]) and death with graft function (HR 2.70 [95% CI: 1.76, 4.15]).

Conclusions: Bacteremia is common after kidney transplantation and has important implications for graft and patient survival. Identifying high-risk patients for targeted preventive strategies may reduce the burden and adverse consequences of this important complication.

CITATION INFORMATION: Brar S, Wang Y, Cannitelli A, Li Y, Famure O, Husain S, Kim J. Bacteremia in Kidney Transplant Recipients: Incidence, Risk Factors, and Outcomes. Am J Transplant. 2017;17 (suppl 3).

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