Rostkowska Olga Maria, Kuthan Robert, Burban Anna, Salińska Jagoda, Ciebiera Michał, Młynarczyk Grażyna, Durlik Magdalena
Department of Transplantation Medicine, Nephrology, Internal Diseases, T. Orłowski Institute of Transplantation, Medical University of Warsaw, 59 Nowogrodzka Street, 02-006 Warsaw, Poland.
Chair and Department of Medical Microbiology, Medical University of Warsaw, 5 Chałubińskiego Street, 02-004 Warsaw, Poland.
Antibiotics (Basel). 2020 May 26;9(6):284. doi: 10.3390/antibiotics9060284.
Urinary tract infections (UTIs) are the most common bacterial infections among kidney transplant (KTX) recipients. The purpose of this study was to analyze antimicrobial resistance (AMR) in four most common pathogens responsible for UTIs in KTX recipients and determine risk factors (RF) for resistance in the same group. Analyzed antibiograms were based on urine samples positive for bacterial growth of 10 colony-forming units (CFU)/mL obtained from hospitalized adult KTX recipients presenting with UTI symptoms upon admission to the center in years 2011-2018. In total, 783 antibiograms were analyzed for (258 samples, 33.0%), (212, 27.0%), (128, 24.0%), and (125, 16.0%). The decrease in susceptibility of to amoxicillin/clavulanic acid (62.9% vs. 40.0%) and ciprofloxacin (100% to 40.0%) was observed. Susceptibility to gentamicin increased from 33.3% to 92.9% in . Susceptibility to tigecycline remained 100% through all years in case of and . Male gender was a RF for resistance to amoxicillin/clavulanic acid ( = 0.008), ciprofloxacin ( = 0.0003), trimethoprim/sulfamethoxazole ( = 0.00009), ceftriaxone ( = 0.0001), and cefuroxime axetil ( = 0.00038) in and against gentamicin in ( = 0.015). Higher resistance to ampicillin in ( = 0.012) and to ciprofloxacin ( = 0.0003), trimethoprim/sulfamethoxazole ( = 0.007), piperacillin/tazobactam ( = 0.003), ceftriaxone ( = 0.001), and cefuroxime axetil ( = 0.013) in was observed in higher age groups of patients. Diabetes as a cause of kidney insufficiency ( = 0.026) and kidney-pancreas transplantation ( = 0.014) was RF for resistance to ceftriaxone in . AMR in uropathogens from KTX recipients fluctuated. There were identifiable RFs for resistance in the examined bacteria-antibiotic combinations. We recommend continuous mapping of site-specific microorganisms as etiology and susceptibility may vary between institutions and over time.
尿路感染（UTIs）是肾移植（KTX）受者中最常见的细菌感染。本研究的目的是分析导致KTX受者UTIs的四种最常见病原体的抗菌药物耐药性（AMR），并确定同一组中耐药的危险因素（RF）。分析的抗菌谱基于2011 - 2018年期间入住该中心时出现UTI症状的住院成年KTX受者尿液样本中细菌生长为10个菌落形成单位（CFU）/mL且呈阳性的情况。总共分析了783份抗菌谱，其中大肠埃希菌（258份样本，33.0%）、肺炎克雷伯菌（212份，27.0%）、奇异变形杆菌（128份，24.0%）和粪肠球菌（125份，16.0%）。观察到大肠埃希菌对阿莫西林/克拉维酸的敏感性降低（62.9%对40.0%）以及对环丙沙星的敏感性降低（100%至40.0%）。奇异变形杆菌对庆大霉素的敏感性从33.3%增加到92.9%。在肺炎克雷伯菌和粪肠球菌的情况下，对替加环素的敏感性多年来一直保持100%。男性是对阿莫西林/克拉维酸（P = 0.008）、环丙沙星（P = 0.0003）、甲氧苄啶/磺胺甲恶唑（P = 0.00009）、头孢曲松（P = 0.0001）和头孢呋辛酯（P = 0.00038）耐药的危险因素，在奇异变形杆菌中男性是对庆大霉素耐药的危险因素（P = 0.015）。在肺炎克雷伯菌中，年龄较大的患者组对氨苄西林的耐药性更高（P = 0.012），对环丙沙星（P = 0.0003）、甲氧苄啶/磺胺甲恶唑（P = 0.007）、哌拉西林/他唑巴坦（P = 0.003）、头孢曲松（P = 0.001）和头孢呋辛酯（P = 0.013）的耐药性也更高。糖尿病作为肾功能不全的病因（P = 0.026）和肾胰腺移植（P = 0.014）是肺炎克雷伯菌对头孢曲松耐药的危险因素。KTX受者尿路病原体的AMR存在波动。在所检查的细菌 - 抗生素组合中存在可识别的耐药危险因素。我们建议持续绘制特定部位的微生物图谱，因为病因和敏感性可能因机构和时间而异。
