From the Department of Infectious Diseases, Karachi, Pakistan.
Exp Clin Transplant. 2023 Jul;21(7):562-567. doi: 10.6002/ect.2023.0087.
Gram-negative rods are the most common cause of bloodstream infection in renal transplant recipients. Acute rejection, urologic abnormalities, and ureteral stents are risk factors. Graft dysfunction is independently associated with gram-negative rod bloodstream infection. Our aim is to investigate the incidence, risk factors, and outcome among living donor renal transplant recipients from Pakistan.
In this case-control study, we reviewed the medical records until June 2021 of renal transplant recipients seen from 2015 to 2019 for gram negative bacteremia. For every case, controls were matched by age, date of transplant, and sex. Demographics, risk factors, graft function, and mortality were compared. Clinical features, immunosuppression, source of blood stream infection, and microbiology were noted in cases.
Of 1677 renal transplant recipients, 44 developed gram negative bacteremia. The incidence was 5.9 per 1000 person-years. Median time since transplant was 5 months. The most common source was urinary tract infection. On univariate analysis, antithymocyte globulin, urinary tract infection, and recurrent urinary tract infections were associated with gram negative bacteremia. On multivariate analysis, urinary tract infection (adjusted odds ratio = 3.46; 95% CI, 1.27-9.37) and recurrent urinary tract infections (adjusted odds ratio = 4.03; 95% CI, 1.15-14.15) were significant risk factors. We found no difference in 30-day mortality and estimated glomerular filtration rate on last follow-up between cases and controls. Kaplan-Meier survival curves showed significant differences in graft survival in patients with gram negative bacteremia. Escherichia coli was the most common organism, with 75% ceftriaxone and 13% imipenem resistance.
The most significant risk factor for gram negative rod bloodstream infection was recurrent urinary tract infections. Timely treatment and prevention of recurrent urinary tract infections areimperative for prevention of gram negative bacteremia.
革兰氏阴性杆菌是肾移植受者血流感染的最常见原因。急性排斥反应、泌尿道异常和输尿管支架是危险因素。移植物功能障碍与革兰氏阴性杆菌血流感染独立相关。我们的目的是调查来自巴基斯坦的活体供肾移植受者中革兰氏阴性杆血流感染的发生率、危险因素和结局。
在这项病例对照研究中，我们回顾了 2015 年至 2019 年间因革兰氏阴性菌血症就诊的肾移植受者的病历，直至 2021 年 6 月。每例病例均按年龄、移植日期和性别与对照相匹配。比较了人口统计学、危险因素、移植物功能和死亡率。记录了病例的临床特征、免疫抑制、血流感染源和微生物学。
在 1677 例肾移植受者中，44 例发生革兰氏阴性菌血症。发病率为每 1000 人年 5.9 例。中位移植后时间为 5 个月。最常见的来源是尿路感染。在单因素分析中，抗胸腺细胞球蛋白、尿路感染和复发性尿路感染与革兰氏阴性菌血症有关。在多因素分析中，尿路感染（调整后的优势比=3.46；95%可信区间，1.27-9.37）和复发性尿路感染（调整后的优势比=4.03；95%可信区间，1.15-14.15）是显著的危险因素。我们在病例和对照组之间没有发现 30 天死亡率和最后一次随访时估计肾小球滤过率的差异。Kaplan-Meier 生存曲线显示，革兰氏阴性菌血症患者的移植物存活率存在显著差异。大肠埃希菌是最常见的病原体，头孢曲松耐药率为 75%，亚胺培南耐药率为 13%。
革兰氏阴性杆菌血流感染的最重要危险因素是复发性尿路感染。及时治疗和预防复发性尿路感染对于预防革兰氏阴性菌血症至关重要。
