Department of Pharmaceutical Practices, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Banner - University Medical Center Tucson, Tucson, AZ, USA.
Banner - University Medical Center Tucson, Tucson, AZ, USA; Division of Infectious Diseases, Department of Medicine, University of Arizona, Tucson, AZ, USA.
J Glob Antimicrob Resist. 2018 Mar;12:119-123. doi: 10.1016/j.jgar.2017.08.009. Epub 2017 Aug 30.
Urinary tract infection (UTI) recurrence and antimicrobial resistance remain a common problem in kidney transplant recipients. Whilst the use of annual institutional antibiograms may help guide appropriate empirical antibiotic selection, these non-disease specific antibiograms do not always account for patient-specific risk factors or disease-specific resistance patterns. This study determined the frequency of UTI recurrence during the first year after kidney transplantation as well as differences in antimicrobial susceptibility between an institutional antibiogram and the disease-specific antibiogram for patients following kidney transplantation.
In this study, adult patients with at least one UTI during an inpatient admission within 1 year post kidney transplantation were evaluated. A disease-specific antibiogram for UTIs in kidney transplant recipients was prepared based on culture results and was compared with the annual institutional antibiograms.
Of 299 kidney transplants performed during the study period, 66 subjects meet the study inclusion criteria, of whom 47% had two or more UTIs within the first year after kidney transplant. In comparison with the institutional antibiogram, Escherichia coli isolated from urine samples from kidney transplant recipients were significantly more resistant to trimethoprim/sulfamethoxazole, ceftriaxone, cefepime, ciprofloxacin and gentamicin (P<0.0001).
Multiple UTIs are common in kidney transplant recipients during the first year post-transplantation. E. coli urinary isolates were significantly more resistant to multiple antibiotic drug classes in this patient population compared with the general hospital population. Antimicrobial stewardship programmes at transplant centres should consider producing disease-specific antibiograms specifically for transplant recipients to improve empirical antibiotic selection guidance.
尿路感染（UTI）的复发和抗菌药物耐药仍然是肾移植受者的常见问题。虽然使用年度机构药敏谱图可能有助于指导适当的经验性抗生素选择，但这些非疾病特异性药敏谱图并不总是考虑到患者的具体危险因素或疾病特异性耐药模式。本研究确定了肾移植后 1 年内 UTI 复发的频率，以及肾移植患者的机构药敏谱图和疾病特异性药敏谱图之间抗菌药物敏感性的差异。
本研究评估了在肾移植后 1 年内住院期间至少有一次 UTI 的成年患者。根据培养结果制定了肾移植受者 UTI 的疾病特异性药敏谱图，并与年度机构药敏谱图进行比较。
在研究期间进行的 299 例肾移植中，有 66 名患者符合研究纳入标准，其中 47%的患者在肾移植后 1 年内有两次或两次以上 UTI。与机构药敏谱图相比，从肾移植受者尿液样本中分离出的大肠埃希菌对甲氧苄啶/磺胺甲噁唑、头孢曲松、头孢吡肟、环丙沙星和庆大霉素的耐药性明显更高（P<0.0001）。
肾移植受者在移植后 1 年内经常发生多次 UTI。与一般医院人群相比，该患者人群中大肠埃希菌尿分离株对多种抗生素药物类别明显更耐药。移植中心的抗菌药物管理计划应考虑为移植受者制定特定的疾病特异性药敏谱图，以改善经验性抗生素选择指导。
