Sabé Núria, Maristany Marta, Tuells Manel, Favà Alexandre, Melilli Edoardo, Tubau Fe, Cruzado Josep Maria, Carratalà Jordi
Infectious Disease Department, Bellvitge University Hospital-IDIBELL, University of Barcelona, 08907 Barcelona, Spain.
Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, 28029 Madrid, Spain.
J Clin Med. 2022 Jun 2;11(11):3165. doi: 10.3390/jcm11113165.
Acute graft pyelonephritis (AGP) is the leading cause of bloodstream infection in kidney transplant (KT) recipients. The prevalence of urinary tract infections caused by multidrug-resistant (MDR) Gram-negative bacilli is increasing. This 14-year prospective observational study sought to determine the clinical characteristics, risk factors, and outcomes of AGP with bacteremia due to MDR Gram-negative bacilli. Overall, 278 episodes of AGP with bacteremia due to MDR Gram-negative and non-MDR Gram-negative bacilli were identified and compared in 214 KT recipients; MDR Gram-negative bacilli were the cause in 28.4%. Overall 30-day mortality was low (1.1%). Risk factors independently associated with AGP due to MDR Gram-negative bacilli were male sex (OR 3.08; 95%CI 1.60-5.93), previous episode of bacteremic AGP (OR 2.11, 95%CI 1.09-4.09), prior antibiotic therapy in the preceding month (OR 2.47, 95%CI 1.33-4.57), and nosocomial acquisition (OR 2.03, 95%CI 1.14-3.62). Forty-three percent of MDR Gram-negative episodes received inappropriate empirical antibiotic therapy. The risk factors identified in this study may help physicians when selecting empirical antibiotic treatment for AGP. Previous antibiotic use was the main modifiable factor. Its presence highlights the importance of avoiding unnecessary antibiotics in order to bring down the high rates of MDR Gram-negative bacilli infections in this population.
急性移植肾盂肾炎（AGP）是肾移植（KT）受者血流感染的主要原因。由多重耐药（MDR）革兰氏阴性杆菌引起的尿路感染患病率正在上升。这项为期14年的前瞻性观察研究旨在确定由MDR革兰氏阴性杆菌引起的伴有菌血症的AGP的临床特征、危险因素和结局。总体而言，在214名KT受者中识别并比较了278例由MDR革兰氏阴性和非MDR革兰氏阴性杆菌引起的伴有菌血症的AGP病例；MDR革兰氏阴性杆菌是病因的占28.4%。总体30天死亡率较低（1.1%）。与由MDR革兰氏阴性杆菌引起的AGP独立相关的危险因素为男性（比值比3.08；95%置信区间1.60 - 5.93）、既往菌血症性AGP发作（比值比2.11，95%置信区间1.09 - 4.09）、前一个月内曾接受抗生素治疗（比值比2.47，95%置信区间1.33 - 4.57）以及医院获得性感染（比值比2.03，95%置信区间1.14 - 3.62）。43%的MDR革兰氏阴性菌感染病例接受了不恰当的经验性抗生素治疗。本研究中确定的危险因素可能有助于医生为AGP选择经验性抗生素治疗。既往使用抗生素是主要的可改变因素。它的存在凸显了避免不必要的抗生素使用以降低该人群中MDR革兰氏阴性杆菌感染高发生率的重要性。
