Premium
Epidemiology and outcomes of carbapenem‐resistant K lebsiella pneumoniae bacteriuria in kidney transplant recipients
Author(s) -
Pouch S.M.,
Kubin C.J.,
Satlin M.J.,
Tsapepas D.S.,
Lee J.R.,
Dube G.,
Pereira M.R.
Publication year - 2015
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/tid.12450
Subject(s) - bacteriuria , medicine , odds ratio , urinary system
Background Little is known about the epidemiology of carbapenem‐resistant K lebsiella pneumoniae ( CRKP ) bacteriuria following kidney transplantation. We determined the incidence of post‐transplant CRKP bacteriuria in adults who underwent kidney transplant from 2007 to 2010 at 2 New York City centers. Methods We conducted a case–control study to identify factors associated with CRKP bacteriuria compared with carbapenem‐susceptible K . pneumoniae ( CSKP ) bacteriuria, assessed whether CRKP bacteriuria was associated with mortality or graft failure, and compared outcomes of treated episodes of CRKP and CSKP bacteriuria. Results Of 1852 transplants, 20 (1.1%) patients developed CRKP bacteriuria. Factors associated with CRKP bacteriuria included receipt of multiple organs (odds ratio [ OR ] 4.7, 95% confidence interval [ CI ] 1.1–20.4), deceased‐donor allograft ( OR 5.9, 95% CI 1.3–26.8), transplant admission length of stay ( OR 1.1 per day, 95% CI 1.0–1.1), pre‐transplant CRKP infection or colonization ( OR 18.3, 95% CI 2.0–170.5), diabetes mellitus ( OR 2.8, 95% CI 1.0–7.8), and receipt of antimicrobials other than trimethoprim‐sulfamethoxazole ( OR 4.3, 95% CI 1.6–11.2). Conclusion Compared to CSKP bacteriuria, CRKP bacteriuria was associated with increased mortality (30% vs. 10%, P = 0.03) but not graft failure. Treated episodes of CRKP bacteriuria were less likely to achieve microbiologic clearance (83% vs. 97%; P = 0.05) and more likely to recur within 3 months (50% vs. 22%, P = 0.02) than CSKP episodes. CRKP bacteriuria after kidney transplant is associated with mortality and antimicrobial failure after treatment.