Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Nephrology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Excellence Center of Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Am J Med Sci. 2021 Mar;361(3):352-357. doi: 10.1016/j.amjms.2020.10.011. Epub 2020 Oct 12.
Multi-drug resistant organisms have been emerging among kidney transplant (KT) recipients with bloodstream infections (BSI). The investigation for epidemiology, risk factors and outcome of these infections following KT was initiated.
A retrospective study of all adult KT recipients who developed a BSI within the first year after KT in 2016 at a single transplant center was conducted. The cumulative incidence of BSI was estimated with Kaplan-Meier methodology. Clinical characteristics and outcome were extracted. Risk factors were analyzed with Cox proportional hazards models.
Among 171 KT recipients, there were 26 (15.2%) episodes of BSI. Fifty-nine percent were men and the mean ± SD age was 43 ± 12 years. The cumulative incidence of BSIs was 10.1% at 1 month, 13.5% at 6 months, and 15.2% at 12 months. Gram-negative bacteria were responsible for 92% of BSIs, Escherichia coli was the most common pathogen (65%) followed by Klebsiella pneumoniae (11%). Among those, 71% were resistant to extended-spectrum cephalosporins. The genitourinary tracts were the predominant source of BSIs (85%). The second kidney transplantation (HR, 4.55; 95% CI, 1.24-16.79 [P = 0.02]) and receiving induction therapy (HR, 3.05; 95% CI, 1.15-8.10 [P < 0.03]) were associated with BSI in a multivariate analysis. One patient (4%) developed allograft rejection, allograft failure and death from septic shock.
One out of six KT recipients could develop BSI from gram-negative bacteria within the first year after transplant, particularly in those that received the second transplantation or induction therapy.
血液感染（BSI）中出现了越来越多的耐多药生物体，这些生物体在肾移植（KT）受者中。为了调查这些感染的流行病学、危险因素和结果，我们开始了这项研究。
对 2016 年在一个单一移植中心接受 KT 的所有成年 KT 受者，在 KT 后一年内发生 BSI 的情况进行了回顾性研究。采用 Kaplan-Meier 方法估计 BSI 的累积发生率。提取临床特征和结果。采用 Cox 比例风险模型分析危险因素。
在 171 名 KT 受者中，有 26 例（15.2%）发生 BSI。59%为男性，平均年龄为 43±12 岁。BSI 的累积发生率为 1 个月时为 10.1%，6 个月时为 13.5%，12 个月时为 15.2%。革兰氏阴性菌占 BSIs 的 92%，大肠杆菌是最常见的病原体（65%），其次是肺炎克雷伯菌（11%）。其中 71%对头孢菌素类抗生素耐药。泌尿道是 BSI 的主要来源（85%）。二次肾移植（HR，4.55；95%CI，1.24-16.79[P=0.02]）和接受诱导治疗（HR，3.05；95%CI，1.15-8.10[P<0.03]）与多变量分析中的 BSI 相关。1 例（4%）患者发生移植肾排斥反应、移植肾失功和感染性休克死亡。
在移植后一年内，每 6 例 KT 受者中就有 1 例可能会发生革兰氏阴性菌引起的 BSI，尤其是接受二次移植或诱导治疗的患者。
