Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France.
Nephrology and Transplantation Unit, La Cavale Blanche University Hospital. Brest, France.
Infect Dis Now. 2024 Aug;54(5):104922. doi: 10.1016/j.idnow.2024.104922. Epub 2024 May 14.
Acute graft pyelonephritis (AGPN) is the most frequent infectious complication in kidney transplant recipients (KTR). The treatment of acute community-acquired (CA) pyelonephritis is based on third-generation cephalosporins (3GC) and fluoroquinolones. Cefepime or a piperacillin-tazobactam combination are more often used in healthcare-associated (HCA) infections. However, these recommendations do not consider the resistance observed in KTRs. The objective of our study was to define the most appropriate empirical antibiotherapy for AGPN in KTRs according to the CA and HCA settings. To answer this question, we assessed the prevalence of resistance to different antibiotics usually recommended for urinary tract infections (UTIs) in the general population.
Observational, retrospective, multicenter study covering all episodes of AGPN occurring in hospitalized KTRs in 2019.
A total of 210 patients were included in 7 centers and 244 episodes of AGPN were analyzed (158 CA-AGPN and 86 HCA-AGPN). The prevalence of 3GC and fluoroquinolone resistance was 23 % (n = 36) and 30 % (n = 50) in CA infections (n = 158), and 47 % (n = 40) and 31 % (n = 27) in HCA infections (n = 86), respectively. Cefepime resistance rate was 19 % (n = 30) in CA-AGPN and 29 % (n = 25) in HCA-AGPN. Piperacillin-tazobactam combination had resistance rates > 15 % in both CA and HCA infections. The only antimicrobials with resistance rates < 10 % were aminoglycosides and carbapenems.
None of the antibiotics recommended in empirical treatment in UTIs has shown a resistance rate of less than 10% with regard to AGPN. Therefore, none of them should be used as monotherapy. A combination therapy including amikacin could be an appropriate strategy in this setting.
急性移植物肾盂肾炎（AGPN）是肾移植受者（KTR）最常见的感染性并发症。急性社区获得性（CA）肾盂肾炎的治疗基于第三代头孢菌素（3GC）和氟喹诺酮类药物。头孢吡肟或哌拉西林-他唑巴坦联合治疗在医源性（HCA）感染中更为常用。然而，这些建议并未考虑到 KTR 中观察到的耐药性。本研究的目的是根据 CA 和 HCA 环境，确定 KTR 中 AGPN 最合适的经验性抗生素治疗方法。为了回答这个问题，我们评估了通常推荐用于治疗尿路感染（UTI）的不同抗生素在普通人群中的耐药率。
这是一项观察性、回顾性、多中心研究，涵盖了 2019 年住院 KTR 中发生的所有 AGPN 病例。
共有 7 个中心的 210 名患者和 244 例 AGPN 被纳入研究（158 例 CA-AGPN 和 86 例 HCA-AGPN）。CA 感染（n=158）中 3GC 和氟喹诺酮类药物的耐药率分别为 23%（n=36）和 30%（n=50），HCA 感染（n=86）中分别为 47%（n=40）和 31%（n=27）。头孢吡肟耐药率在 CA-AGPN 中为 19%（n=30），在 HCA-AGPN 中为 29%（n=25）。哌拉西林-他唑巴坦联合治疗在 CA 和 HCA 感染中耐药率均>15%。仅氨基糖苷类和碳青霉烯类药物的耐药率<10%。
在 AGPN 的经验性治疗中，没有一种推荐的抗生素的耐药率低于 10%。因此，它们都不应该作为单一疗法使用。在这种情况下，包括阿米卡星在内的联合治疗可能是一种合适的策略。
