Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: narrowing of the therapeutic options. Issue 4 (4th July 2016)

• Record Type: Journal Article
• Authors: Origüen, J.; Fernández‐Ruiz, M.; López‐Medrano, F.; Ruiz‐Merlo, T.; González, E.; Morales, J.M.; Fiorante, S.; San‐Juan, R.; Villa, J.; Orellana, M.Á.; Andrés, A.; Aguado, J.M.
• Is Part Of: Transplant infectious disease. Volume 18:Issue 4(2016)
• Page Start: 575
• Page End: 584
• Publication Date: 2016-07-04
• Subjects: kidney transplantation -- antibiotic resistance -- gram‐negative bacilli -- urine culture -- uropathogen; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12547
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Background: Antibiotic resistance is an emerging phenomenon in kidney transplantation (KT). Methods: We compared species distribution and antimicrobial susceptibility patterns in 1052 isolates from urine cultures obtained in 2 different cohorts of kidney transplant recipients in a single center (Cohort A: 189 patients undergoing KT between January 2002 and December 2004 [336 isolates]; Cohort B: 115 patients undergoing KT between January 2011 and December 2013 [716 isolates]). Results: Asymptomatic bacteriuria accounted for most of the isolates (86.9% in Cohort A and 92.3% in Cohort B). Klebsiella pneumoniae (9.5% vs. 15.6%), Pseudomonas aeruginosa (1.8% vs. 7.9%), and Enterobacter cloacae (0.6% vs. 3.1%) were significantly more common in Cohort B. The isolation of K. pneumoniae in Cohort B was associated with the occurrence of acute pyelonephritis (9.8% of all K. pneumoniae isolates vs. 2.8% of the remaining uropathogens; P = 0.001). Non‐susceptibility rates among Enterobacteriaceae in Cohort B were higher for every class of antibiotics ( P ≤ 0.003) with the exception of fosfomycin. Compared to Cohort A, significant increases were seen in isolates from Cohort B for multidrug‐resistant (MDR) (43.9% vs. 67.8%, respectively; P = 0.001), extended‐spectrum beta‐lactamase (ESBL)‐producing (6.6% vs. 26.1%; P = 0.001), and carbapenemase‐producing Enterobacteriaceae strains (0.0% vs. 5.0%; P = 0.001). Such differences were mostly attributable to K. pneumoniae (as 54.5% and 13.4% of isolates in Cohort B were ESBL‐producing and carbapenemase‐producing, respectively). MDR isolates were responsible for 69.1% of episodes of symptomatic urinary tract infection in Cohort B. Conclusion: The increase in resistance rates among Enterobacteriaceae uropathogens is significant and may have an effect on KT programs.