Delmas-Frenette Catherine, Dorais Marc, Tavares-Brum Alexandre, Frenette Charles, Yang Bing, Medani Samar, Duclos Alain, Rouleau Danielle, Mawad Habib, Barama Azemi, Cardinal Heloise
Department of Medicine, Centre Hospitalier de l'Universite de Montreal (CHUM), Montreal, QC, Canada.
Statsciences, Notre-Dame de l'Ile Perrot, QC, Canada.
Transpl Infect Dis. 2017 Aug;19(4). doi: 10.1111/tid.12722. Epub 2017 Jul 3.
In kidney transplant recipients, episodes of bacteriuria are often treated regardless of the presence of symptoms because of the lack of clear treatment guidelines suggesting otherwise. This practice may lead to the development of antimicrobial resistance. Our aim was to determine the incidence, determinants, and impact of antimicrobial resistance in kidney transplant recipients with gram-negative bacteriuria.
We conducted a single-center, retrospective cohort study in patients who underwent kidney transplantation between January 2008 and June 2013. To identify risk factors for the development of resistance, we used a logistic regression model with generalized estimating equations to account for within-subject correlation.
Among the 318 patients who underwent kidney transplantation during the study period, 147 patients developed 555 gram-negative episodes of bacteriuria. Resistance to trimethoprim-sulfamethoxazole and quinolones, and production of extended-spectrum β-lactamase (ESBL) occurred in 52%, 21%, and 5% of isolated microorganisms, respectively. An increased risk of resistance to quinolones and production of ESBL were associated with concomitant diabetes (odds ratio [OR]: 2.29, 95% confidence interval [CI]: 1.11-4.74), the first year post transplantation (OR: 2.88, 95% CI: 1.36-6.09), and antibiotic treatment in the previous 6 months (OR: 3.36, 95% CI: 1.66-6.81). This resistance profile was also associated with the presence of symptoms, a longer duration of antibiotic treatment, and a higher rate of hospitalization.
Antimicrobial resistance to quinolones and production of ESBL were commonly seen, and were shown to demonstrate an adverse impact on outcomes in kidney transplant recipients with gram-negative bacteriuria. The decision on treatment for asymptomatic bacteriuria should be made with caution, given the potential for the selection of resistant strains.
在肾移植受者中，由于缺乏明确的相反治疗指南，菌尿发作通常无论有无症状都进行治疗。这种做法可能导致抗菌药物耐药性的产生。我们的目的是确定肾移植受者革兰氏阴性菌尿抗菌药物耐药性的发生率、决定因素及影响。
我们对2008年1月至2013年6月期间接受肾移植的患者进行了一项单中心回顾性队列研究。为了确定耐药性产生的危险因素，我们使用了带有广义估计方程的逻辑回归模型来考虑受试者内部的相关性。
在研究期间接受肾移植的318例患者中，147例患者发生了555次革兰氏阴性菌尿发作。分离出的微生物中，对甲氧苄啶-磺胺甲恶唑和喹诺酮类药物的耐药率分别为52%、21%，产超广谱β-内酰胺酶（ESBL）的比例为5%。喹诺酮类药物耐药性增加及产ESBL与合并糖尿病（比值比[OR]：2.29，95%置信区间[CI]：1.11 - 4.74）、移植后第一年（OR：2.88，95%CI：1.36 - 6.09）以及前6个月内使用抗生素治疗（OR：3.36，95%CI：1.66 - 6.81）有关。这种耐药情况还与症状的存在、抗生素治疗时间延长以及较高的住院率相关。
喹诺酮类药物抗菌耐药性及产ESBL很常见，并且已显示对革兰氏阴性菌尿的肾移植受者的预后有不利影响。鉴于存在选择耐药菌株的可能性，对于无症状菌尿的治疗决策应谨慎做出。
