Increasing Resistance in Gramnegative Bacilli Causing Urinary Tract Infection (UTI) in Two Cohorts of Kidney Transplant (KT) Recipients: An Emerging Problem
Hospital 12 de Octubre, Madrid, Spain
Meeting: 2013 American Transplant Congress
Abstract number: B1047
Background
UTI is the most common infection following KT. The increasing resistance in gramnegative bacilli could have an special impact on this population.
Methods
Two cohorts were followed up in our center during 2 different periods: 189 patients included in a previous study (Fiorante S et Al. Kidney International 2010) receiving a KT from February 2002 to July 2006 (group A), and 63 that received a KT from January 2011 to August 2012 (group B). The microbiological isolates of all episodies of UTI (asymptomatic bacteriurias, cystitis and pyelonephritis (PN)) were registered. We compared our cohorts to detect changes in epidemiology and antibiotic patterns of resistance.
Results
There were 343 episodes of bacteriuria in group A with 36 (10.5%) symptomatic episodes (17 PN and 19 cystitis). There were 198 episodes of bacteriuria in group B, with 14 (7%) symptomatic episodes (6 PN and 8 cystitis). Escherichia coli was the microorganism most frequently isolated in both groups (58.3% in group A vs 53.5% in group B) followed by Klebsiella pneumoniae (9.3% vs 11.1%) and Enterococcus faecalis (11% vs 10.6%). The number of bacteriurias by Pseudomonas aeruginosa was higher in group B (9.1 % vs 2%; p=.001). The frequency of Streptococcus agalactiae was lower in group B (1% vs 5.2%; p=.008). The % of resistances to most antibiotics in Enterobacteriaceae significantly increased in group B (Table). The % of extended-spectrum beta-lactamase-producing Enterobacteriaceae was higher in group B (17.9% vs 6.6%; p=.001). The resistance of P. aeruginosa was higher in group B, although without significant difference: ceftazidime (6/18 isolates in group B vs 0/7 in group A), imipenem (4/18 vs 0/7) and quinolones (7/18 vs 1/7).
| Group A(n=255) | Group B(n=140) | p | |
| AMOX | 201(78.8) | 132(94.3) | 0.000 |
| AMOX-CLAV | 32(12.5) | 58(41.4) | 0.000 |
| PIP-TAZ | 7(2.7) | 22(15.7) | 0.000 |
| CEFAZOL | 89(34.9) | 92(65.7) | 0.000 |
| CEFUROX | 39(15.3) | 40(28.6) | 0.002 |
| CEFOTAX | 24(9.4) | 30(21.4) | 0.001 |
| GENTA | 29(11.4) | 26(18.6) | NS |
| NITROF | 25(9.8) | 18(12.9) | NS |
| CIPRO | 94(36.8) | 69(49.3) | 0.020 |
| TMP/SMX | 176(69) | 129(92.1) | 0.000 |
| FOSFO | 25(9.8) | 15(10.7) | NS |
Conclusion
In the last decade, we have detected an alarming increase in the resistances of gramnegative bacilli producing UTI in KT recipients. This should be taken into account when adopting preventive and empirical therapeutical measures.
To cite this abstract in AMA style:
Origüen J, López-Medrano F, Pérez-Jacoiste A, García-Reyne A, Carrasco N, Orellana M, Andrés A, Morales J, Aguado J. Increasing Resistance in Gramnegative Bacilli Causing Urinary Tract Infection (UTI) in Two Cohorts of Kidney Transplant (KT) Recipients: An Emerging Problem [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/increasing-resistance-in-gramnegative-bacilli-causing-urinary-tract-infection-uti-in-two-cohorts-of-kidney-transplant-kt-recipients-an-emerging-problem/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress