Risk and prognosis of bacteremia and fungemia among first-time kidney transplant recipients: a population-based cohort study

Incidencia de infecciones en el postrasplante renal inmediato

Introducción: El receptor de un trasplante renal es un paciente de alto riesgo para sufrir infección debido a las potenciales complicaciones quirúrgicas y al tratamiento inmunosupresor que reciben.El desarrollo de infecciones supone un riesgo aumentado de pérdida del injerto y de la mortalidad. Objetivos: El objetivo principal fue conocer la incidencia de las infecciones más frecuentes en el paciente con un trasplante renal, durante el periodo postrasplante inmediato.Los objetivos secundarios fueron describir los gérmenes responsables de las infecciones más frecuentes y analizar la relación entre los tipos de infección estudiados y sus posibles factores de riesgo. Metodología: Estudio observacional retrospectivo en pacientes trasplantados renales entre enero de 2018 y diciembre de 2019 durante el periodo del postrasplante inmediato.Resultados: La incidencia de infección fue 69,4%, los síndromes descritos fueron infección del tracto urinario (48%), bacteriemia (9,2%), infección relacionada con catéter (8,2%) e infección por citomegalovirus (4,1%). Los microorganimos más frecuentemente implicados, en estos procesos infecciosos fueron Escherichia coli (16,3%), Enterococus faecium (12,2%) y Enterobacter cloacae (8,1%).Se ha encontrado relación significativa entre la aparición de infección y la duración del ingreso, así como con la presencia o no del antecedente personal de hipertensión arterial. También entre la incidencia de infección relacionada con el catéter venoso central y el tiempo que permaneció insertado. Conclusiones: La infección más frecuente encontrada en el postrasplante renal inmediato fue la infección del tracto urinario, mientras que el microorganismo más presente habitualmente en los procesos infecciosos fue la Escherichia coli.

Bloodstream infections by gram-negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome

BACKGROUND

Kidney transplant recipients (KTRs) are at increased risk of infections.

METHODS

The aims of this study were to describe the incidence of bloodstream infections (BSIs) by gram-negative bacteria in a cohort of KTRs, the risk factors for BSI due to multi-drug-resistant (MDR) gram-negative bacteria, and the predictors for unfavorable outcome, defined as death or nephrectomy or return to dialysis, within 30 days from BSI. We conducted a retrospective cohort study at the renal transplant unit of a tertiary care hospital in Athens, Greece.

RESULTS

In a total of 1962 KTRs, we recorded 195 BSI episodes in 182 single patients (male/female = 97/85), with a median (interquartile range) age of 57.2 (44-64.9) years. The incidence was 1.393/100 patient-years. The most common source of infection was urinary tract (70.9%), and Escherichia coli (63.7%) was the most common pathogen. 19.2% of the infecting organisms were MDR; previous antibiotic use (OR 8.2; CI 2.1-32.9) and previous stay in the intensive care unit (OR 34.2; CI 1.6-730.2) were associated with MDR BSIs. 6% of patients died, and 2.2% underwent nephrectomy, while no patients had to return to dialysis. Diabetes mellitus (OR 8.1; 95% CI 1.3-50.3), Pseudomonas aeruginosa BSI (OR 46.1; 95% CI 3.9-552.3), and septic shock (OR 46.7; 95% CI 1.7-1304.9) were independent predictors of unfavorable outcome.

CONCLUSION

Bloodstream infections in KTRs have a significant impact on allograft and patients outcome.

Bacteremia in kidney transplant recipients: Burden, causes, and consequences

Bacteremia is an important complication after kidney transplantation. We examined bacteremia and its outcomes in a large cohort of kidney transplant recipients. Kidney transplants from 1-Jul-2004 to 1-Dec-2014 at the Toronto General Hospital were eligible for study inclusion. Bacteremia was defined as two blood culture positives for common skin contaminants or one blood culture positive for other organisms. The cumulative incidence of first bacteremia was estimated using the Kaplan-Meier method, and risk factors were examined in a Cox proportional hazards model. The risk of graft failure or death was assessed in a time-dependent Cox model. Over follow-up, 154 of 1333 patients had at least one bacteremia episode. The cumulative incidence of first bacteremia was 6.8% (6 months) and 11.9% (5 years). Risk factors included recipient diabetes mellitus, time on dialysis, dialysis modality, delayed graft function, donor age, and donor eGFR. Bacteremia increased the risk of total graft failure (hazard ratio 2.11 [95% CI: 1.50, 2.96]), death-censored graft failure (1.73 [0.99, 3.02]), and death with graft function (2.52 [1.63, 3.89]). In conclusion, bacteremia is common after kidney transplantation and impacts both graft and patient survival. Identifying high-risk patients for targeted preventive strategies may reduce the burden and adverse consequences of this important complication.

Risk factors associated with bloodstream infections in end-stage renal disease patients: a population-based study

BACKGROUND

Bloodstream infections (BSI) commonly complicate end-stage renal disease (ESRD) and are the second most common cause of death in these patients. The objective of this study was to define risk factors for development of BSI and its outcome among ESRD patients.

METHODS

A retrospective, population-based, matched cohort design was utilized. All adult (18 or older) residents of the western interior of British Columbia with ESRD who had a first BSI between April 2010 and March 2017 were included. Subject cases were then matched 1:1 with an ESRD patient from the regional registry who did not have a BSI.

RESULTS

During the study period a total of 53 cases of incident BSI were identified among patients with ESRD. The median age was 70.7 (interquartile range, 61.9-79.6) years and 28 (53%) were male. The most common organism isolated was Staphylococcus aureus (17 cases; 32%). Compared to controls, case patients were significantly (p < .05) more likely to have higher Charlson comorbidity scores (mean difference (MD): 1.4; 95% CI (0.5, 2.2)), and have lower serum albumin (MD: -3.3; 95% CI (-5.5, -1.2)). Diabetes was not significant; however, cases were twice as likely to be diabetic (OR: 2.0; 95% CI (0.9, 4.8)). Case fatality rates for 30- and 90-days were 8/53 (15%) and 13/53 (25%) respectively, whereas no control patients died (p < .05).

CONCLUSIONS

ESRD patients with higher co-morbid illness, and lower serum albumin are at an increased risk for development of a BSI. Development of BSI among ESRD patients is associated with higher fatality rates.