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Risk Factors for Infection with Extended‐Spectrum and AmpC β‐Lactamase‐Producing Gram‐Negative Rods in Renal Transplantation
Author(s) -
Linares L,
Cervera C.,
Cofán F,
Lizaso D.,
Marco F,
Ricart M. J,
Esforzado N,
Oppenheimer F,
Campistol J. M,
Moreno A
Publication year - 2008
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/j.1600-6143.2008.02197.x
Subject(s) - medicine , bacilli , incidence (geometry) , antibiotics , kidney transplantation , transplantation , population , microbiology and biotechnology , gastroenterology , biology , bacteria , physics , genetics , environmental health , optics
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.