Risk Factors for Infection with Extended‐Spectrum and AmpC β‐Lactamase‐Producing Gram‐Negative Rods in Renal Transplantation

• Published in: American journal of transplantation Vol. 8; no. 5; pp. 1000 - 1005
• Main Authors: Linares, L, Cervera, C., Cofán, F, Lizaso, D., Marco, F, Ricart, M. J, Esforzado, N, Oppenheimer, F, Campistol, J. M, Moreno, A
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-05-2008; Blackwell
• Subjects: Adult; Anti-Bacterial Agents - therapeutic use; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacterial Proteins - metabolism; beta-Lactamases - metabolism; Biological and medical sciences; Cephalosporin resistance; Cohort Studies; desrepressed chromosomic AmpC β‐lactamase; Drug Resistance, Multiple; Epidemiology; Escherichia coli; Escherichia coli - isolation & purification; Escherichia coli - metabolism; extended‐spectrum β‐lactamase; Female; General aspects; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - metabolism; gram‐negative rods; Humans; Incidence; Kidney Transplantation; Klebsiella; Klebsiella - isolation & purification; Klebsiella - metabolism; Male; Medical sciences; Middle Aged; pancreas transplantation; Pharmacology. Drug treatments; Public health. Hygiene; Public health. Hygiene-occupational medicine; Renal Dialysis; renal transplantation; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; extended-spectrum β-lactamase; risk factors; β-Lactams; Rod; renal transplantation; pancreas transplantation; Homotransplantation; Epidemiology; Kidney; gram-negative rods; Infection; Resistance; Cephalosporin resistance; Cephalosporin derivatives; Treatment; Urinary system; Surgery; Risk factor; desrepressed chromosomic AmpC β-lactamase; Graft; Antibacterial agent; Pancreas; Gram negative bacteria; Kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2008.02197.x

Increasing prevalence of infections caused by multi‐resistant gram‐negative enteric bacilli due to synthesis of extended‐spectrum β‐lactamase (ESBL) or to desrepressed chromosomic AmpC β‐lactamase (AmpC) is a major concern in the hospitalized patient population. Renal transplant recipients are especially susceptible to these infections. A cohort observational study in a 3‐year period was performed. ESBL‐production was determined by phenotypic analysis based on the CLSI recommendations. A multi‐variate logistic regression analysis was performed to identify independent variables associated with multi‐resistant gram‐negative bacilli infection. The study included 417 patients (61 double kidney‐pancreas recipients). The incidence of ESBL‐producing and desrepressed chromosomic AmpC β‐lactamase resistance was 11.8% (49 patients). The most frequent bacteria isolated was E. coli (35/60 isolations), followed by Klebsiella spp (12/60 isolations). Double kidney‐pancreas transplantation (OR 3.5, CI95% 1.6–7.8), previous use of antibiotics (OR 2.1,CI95% 1.1–4.1), posttransplant dialysis requirement (OR 3.1, CI95% 1.5–6.4) and posttransplant urinary obstruction (OR 5.8, CI95% 2.2–14.9) were independent variables associated with these multi‐resistant gram‐negative enteric bacilli infections. The incidence of ESBL‐producing and desrepressed AmpC β‐lactamase gram‐negative enteric bacilli infection in our population was high. These infections are associated with significant morbidity after renal transplantation.
In 417 kidney and kidney‐pancreas transplant recipients, the incidence of infection with ESBL‐producing and AmpCβ‐lactamase‐producing gram‐negative rods among gram‐negative bacilli infections was 11.8%, associated with kidney‐pancreas transplants, previous antibiotics, post‐transplant dialysis, and post‐transplant urinary obstruction.