Elsevier

Transplantation Proceedings

Volume 50, Issue 6, July–August 2018, Pages 1874-1877
Transplantation Proceedings

13th Congress of the Polish Society of Transplantation: Part I
Kidney transplantation
Clinical Significance of Gastrointestinal Carriage of Klebsiella Pneumoniae-Producing Extended-Spectrum Beta-Lactamases in Kidney Graft Recipients

https://doi.org/10.1016/j.transproceed.2018.03.114Get rights and content

Highlights

  • Klebsiella pneumoniae infections are strongly related to gut colonization.

  • K. pneumoniae gut carriage screening plays an important role after kidney transplantation.

  • This study highlights the increasing role of extended-spectrum beta-lactamase strains.

Abstract

The burden of Klebsiella pneumoniae (KP) producing extended-spectrum beta-lactamases (ESBL+) urinary tract infections (UTIs) is a growing problem after kidney transplantation (KTX). The study was aimed at evaluating the incidence of KP ESBL+ gut colonization in KTX recipients and its correlation with clinical outcomes with special regard to UTIs.

The study included all KTX patients hospitalized in our department between January 2014 and December 2016. During this period 2018 KTX patients were admitted: 605 in 2014, 750 in 2015, and 663 in 2016, respectively. Screening for drug-multiresistant Enterobacteriaceae gut carriage was performed in 104 patients (2014), 122 (2015), and 166 (2016).

In 2014, 2015, and 2016, 18 (17.3%), 26 (21.3%), and 30 (18.1%) patients had positive test results, and 44 (42.3%), 36 (29.5%), and 45 (27.4%) KTX patients were diagnosed with KP ESBL+ UTI. In 2014, KP ESBL+ UTI was diagnosed in 30 (34.9%) cases with negative anal swab and in 14 patients (77.8%) with positive test result (P = .0008). In 2015, KP ESBL+ UTI was diagnosed in 21 patients (21.9%) with negative anal swab and in 15 (57.7%) with positive test result (P = .0004). In 2016, KP ESBL+ UTI was diagnosed in 24 patients (17.8%) with negative anal swab and in 21 (72.4%) with positive test result (P = .000001).

In conclusion, we have revealed a strong association between gut K. pneumoniae colonization, female sex, and MPA intake and KP ESBL+ urinary tract infections in kidney transplant recipients. Our results indicate the very important role of KP ESBL+ screening, while strategies of identified carriers require further research.

Section snippets

Methods

The study included all KTX patients hospitalized in the Department of Immunology, Transplant Medicine and Internal Diseases between January 2014 and December 2016. During this period 2018 KTX patients were admitted: 605 in 2014, 750 in 2015, and 663 in 2016. Screening for multidrug-resistant Enterobacteriaceae gut carriage was performed in 104 cases (2014), 122 (2015), and 166 (2016). All results of screening tests were analyzed and correlated with UTI episodes due to KP ESBL+.

KP susceptibility

Results

Demographic and clinical data of patients with positive KP ESBL+ gut carriage tests are presented in Table 1. In patients with positive screening tests, KP ESBL+ UTI occurred after median 6.7 (interquartile range: 3.2 to 21.5) months after KTX. In 2014 gut KP ESBL+ carriage screening was performed in 104 KTX cases (17.2% of all KTX hospitalizations); 18 cases (17.3%) had positive test results and 44 (42.3%) KTX cases were diagnosed with KP ESBL+ UTI. In 2015 gut KP ESBL+ carriage screening was

Discussion

In solid organ transplant recipients, urinary tract infections constituted 72% of all KP infections [4]. In a study assessing patients after renal transplantation, urinary tract infections due to KP were diagnosed in 12.3% of patients and ESBL+ phenotype constituted approximately 8% of all KP infections [11]. We have analyzed only patients with GI carriage and urinary tract infection caused by KP ESBL+. In patients who underwent KTX, 2.3% to 11.1% developed KP ESBL+ infection in the early

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