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Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: narrowing of the therapeutic options
Author(s) -
Origüen J.,
FernándezRuiz M.,
LópezMedrano F.,
RuizMerlo T.,
González E.,
Morales J.M.,
Fiorante S.,
SanJuan R.,
Villa J.,
Orellana M.Á.,
Andrés A.,
Aguado J.M.
Publication year - 2016
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.12547
Subject(s) - medicine , cohort , fosfomycin , klebsiella pneumoniae , antibiotic resistance , microbiology and biotechnology , antibiotics , kidney transplantation , enterobacter cloacae , enterobacteriaceae , gastroenterology , transplantation , biology , escherichia coli , biochemistry , gene
Background Antibiotic resistance is an emerging phenomenon in kidney transplantation ( KT ). Methods We compared species distribution and antimicrobial susceptibility patterns in 1052 isolates from urine cultures obtained in 2 different cohorts of kidney transplant recipients in a single center (Cohort A: 189 patients undergoing KT between January 2002 and December 2004 [336 isolates]; Cohort B: 115 patients undergoing KT between January 2011 and December 2013 [716 isolates]). Results Asymptomatic bacteriuria accounted for most of the isolates (86.9% in Cohort A and 92.3% in Cohort B). K lebsiella pneumoniae (9.5% vs. 15.6%), P seudomonas aeruginosa (1.8% vs. 7.9%), and E nterobacter cloacae (0.6% vs. 3.1%) were significantly more common in Cohort B. The isolation of K . pneumoniae in Cohort B was associated with the occurrence of acute pyelonephritis (9.8% of all K . pneumoniae isolates vs. 2.8% of the remaining uropathogens; P = 0.001). Non‐susceptibility rates among Enterobacteriaceae in Cohort B were higher for every class of antibiotics ( P ≤ 0.003) with the exception of fosfomycin. Compared to Cohort A, significant increases were seen in isolates from Cohort B for multidrug‐resistant ( MDR ) (43.9% vs. 67.8%, respectively; P = 0.001), extended‐spectrum beta‐lactamase ( ESBL )‐producing (6.6% vs. 26.1%; P = 0.001), and carbapenemase‐producing Enterobacteriaceae strains (0.0% vs. 5.0%; P = 0.001). Such differences were mostly attributable to K . pneumoniae (as 54.5% and 13.4% of isolates in Cohort B were ESBL ‐producing and carbapenemase‐producing, respectively). MDR isolates were responsible for 69.1% of episodes of symptomatic urinary tract infection in Cohort B. Conclusion The increase in resistance rates among Enterobacteriaceae uropathogens is significant and may have an effect on KT programs.