Department of Pharmacy, University of Alabama at Birmingham, Birmingham, USA.
School of Nursing, University of Alabama at Birmingham, Birmingham, USA.
Clin Transplant. 2024 Jul;38(7):e15390. doi: 10.1111/ctr.15390.
Extended-spectrum beta-lactamase-producing gram-negative rods (ESBL-GNR) are a rising cause of bacteremia in kidney transplant recipients (KT). The study purpose was to examine patient mortality, allograft survival, estimated glomerular filtration rate (eGFR) at the end of 1 year, and readmission rates while looking at treatment strategies among KTs with ESBL-GNR and non-ESBL-GNR bacteremia at our institution.
This study was a retrospective, cohort analysis of KTs with gram-negative bacteremia from January 1, 2020, to December 31, 2021. The primary outcome of the study was mortality. Patient outcomes were assessed for 365 days after positive blood cultures.
The study included 63 patients. Of these, 18 (29%) patients had bacteremia caused by an ESBL-GNR and 45 (71%) patients had bacteremia caused by a non-ESBL-GNR. Patient survival at 90 days was 94% in the ESBL-GNR group and 96% in the non-ESBL-GNR group. Ciprofloxacin was the most common antimicrobial therapy at discharge (68.9%) in the non-ESBL-GNR group whereas ertapenem was the most common in the ESBL-GNR group (44.5%). Median eGFR at discharge was 41 mL/min/1.73 m in the ESBL-GNR group and 48 mL/min/1.73 m in the non-ESBL-GNR group. Ninety-day readmission occurred in 9 (50%) ESBL-GNR patients and 14 (32%) non-ESBL-GNR patients. None of the above comparisons are statistically significant (p > 0.05). Eleven (61%) ESBL-GNR and 2 (4%) non-ESBL-GNR patients used outpatient parenteral antimicrobial therapy (p < 0.001).
Among KTs with ESBL-GNR bacteremia, no significant difference was detected in mortality or allograft function compared to non-ESBL-GNR bacteremia.
产超广谱β-内酰胺酶革兰氏阴性杆菌（ESBL-GNR）是肾移植受者（KT）菌血症的一个上升原因。本研究旨在检查我们机构中 ESBL-GNR 和非 ESBL-GNR 菌血症 KT 的患者死亡率、移植物存活率、1 年末估算肾小球滤过率（eGFR）和再入院率，同时观察治疗策略。
本研究是对 2020 年 1 月 1 日至 2021 年 12 月 31 日革兰氏阴性菌血症 KT 的回顾性队列分析。该研究的主要结果是死亡率。在阳性血培养后 365 天评估患者的结局。
该研究纳入了 63 例患者。其中，18 例（29%）患者的菌血症由 ESBL-GNR 引起，45 例（71%）患者的菌血症由非 ESBL-GNR 引起。ESBL-GNR 组 90 天生存率为 94%，非 ESBL-GNR 组为 96%。非 ESBL-GNR 组出院时最常用的抗菌药物治疗是环丙沙星（68.9%），而 ESBL-GNR 组最常用的是厄他培南（44.5%）。ESBL-GNR 组出院时 eGFR 中位数为 41 mL/min/1.73 m，非 ESBL-GNR 组为 48 mL/min/1.73 m。90 天再入院的 ESBL-GNR 患者有 9 例（50%），非 ESBL-GNR 患者有 14 例（32%）。上述比较均无统计学意义（p>0.05）。11 例（61%）ESBL-GNR 和 2 例（4%）非 ESBL-GNR 患者使用了门诊肠外抗菌药物治疗（p<0.001）。
在 ESBL-GNR 菌血症的 KT 中，与非 ESBL-GNR 菌血症相比，死亡率或移植物功能无显著差异。
