Urinary Tract Infections in Kidney Transplant Patients Due to Escherichia coli and Klebsiella pneumoniae-Producing Extended-Spectrum beta-Lactamases: Risk Factors and Molecular Epidemiology

• Type: Article in International Scientific Journal
• Date: 2015

Authors

Espinar, MJ (Author) FMUP; miranda, im (Author) FMUP; Sofia Costa de Oliveira (Author) FMUP; Rocha, R (Author) Other; rodrigues, ag (Author) FMUP; pina-vaz, c (Author) FMUP

Journal

Title: PLoS ONE

Vol. 10

ISSN: 1932-6203

Publisher: Public Library of Science

Indexing

ISI Web of Knowledge - 45 Citations

Scopus - 47 Citations

Other information

Authenticus ID: P-00G-FGV

DOI: 10.1371/journal.pone.0134737

Abstract (EN): Urinary tract infection (UTI) is a common complication after kidney transplantation, often associated to graft loss and increased healthcare costs. Kidney transplant patients (KTPs) are particularly susceptible to infection by Enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBLs). A retrospective case-control study was conducted to identify independent risk factors for ESBL-producing Escherichia coli and Klebsiella pneumoniae in non-hospitalized KTPs with UTI. Forty-nine patients suffering from UTI by ESBL-producing bacteria (ESBL-P) as case group and the same number of patients with UTI by ESBL negative (ESBL-N) as control-group were compared. Clinical data, renal function parameters during UTI episodes, UTI recurrence and relapsing rate, as well as risk factors for recurrence, molecular characterization of isolates and the respective antimicrobial susceptibility profile were evaluated. Diabetes mellitus (p <0.007), previous antibiotic prophylaxis (p=0.017) or therapy (p<0.001), previous UTI (p=0.01), relapsing infection (p=0.019) and patients with delayed graft function after transplant (p=0.001) represented risk factors for infection by ESBL positive Enterobacteriaceae in KTPs. Interestingly, the period of time between data of transplantation and data of UTI was shorter in case of ESBL-P case-group (28.8 months) compared with ESBL-N control-group (50.9 months). ESBL-producing bacteria exhibited higher resistance to fluoroquinolones (p=0.002), trimethoprim-sulfamethoxazole (p<0.001) and gentamicin (p<0.001). Molecular analysis showed that bla(CTX-M) was the most common ESBL encoding gene (65.3%), although in 55.1% of the cases more than one ESBL gene was found. In 29.4% of K. pneumoniae isolates, three bla-genes (bla(CTX-M)-bla(TEM)-bla(SHV)) were simultaneously detected. Low estimated glomerular filtration rate (p=0.009) was found to be risk factor for UTI recurrence. Over 60% of recurrent UTI episodes were caused by genetically similar strains. UTI by ESBL-producing

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 11