Abstract
BackgoundIn recent years we have witnessed an increase in infections due to multidrug-resistant organisms in kidney transplant recipients (KTR). In our setting, we have observed a dramatic increase in infections caused by extended-spectrum betalactamase-producing (ESBL) Enterobacteriaceae in KTR. In 2014 we changed surgical prophylaxis from Cefazolin 2 g to Ertapenem 1 g.MethodsWe compared bacterial infections and their resistance phenotype during the first post-transplant month with an historical cohort collected during 2013 that had received Cefazolin.ResultsDuring the study period 110 patients received prophylaxis with Cefazolin and 113 with Ertapenem. In the Ertapenem cohort we observed a non-statistically significant decrease in the percentage of early bacterial infection from 57 to 47%, with urine being the most frequent source in both. The frequency of infections caused by Enterobacteriaceae spp. decreased from 64% in the Cefazolin cohort to 36% in the Ertapenem cohort (p = 0.005). In addition, percentage of ESBL-producing strains decreased from 21 to 8% of all Enterobacteriaceae isolated (p = 0.015). After adjusted in multivariate Cox regression analysis, male sex (HR 0.16, 95%CI: 0.03–0.75), cefazolin prophylaxis (HR 4.7, 95% CI: 1.1–22.6) and acute rejection (HR 14.5, 95% CI: 1.3–162) were associated to ESBL- producing Enterobacteriaceae infection.ConclusionsPerioperative antimicrobial prophylaxis with a single dose of Ertapenem in kidney transplant recipients reduced the incidence of early infections due to ESBL-producing Enterobacteriaceae without increasing the incidence of other multidrug-resistant microorganisms or C. difficile.
Highlights
Infections are a major complication after kidney transplantation (KT)
We found no differences in the baseline pre-transplant variables, immunosuppression, non-infectious post-transplant complications or the incidence of early infection between cohorts (Table 1)
Sixty-three patients in the Cefazolin group (57%) developed at least one episode of bacterial infection during the first month after transplantation compared to 53 patients (47%) in the Ertapenem group (p = 0.1)
Summary
Infections are a major complication after kidney transplantation (KT). During the first post-transplant month, the majority of infections are caused by bacteria, most of them originating from the urine [1]. In recent years we have observed an increase in the incidence of infections caused by multidrug-resistant microorganisms, especially ESBL-producing Enterobacteriaceae [2]. In our centre we have observed a high incidence of early infections caused by ESBL Enterobacteriaceae; the prevalence of infections caused by ESBL-producing Enterobacteriaceae in 2012 in kidney transplant recipients was 12%, mainly urinary tract infections (80%). For this reason, and based on the published data on the efficacy and safety of Ertapenem for surgical prophylaxis [6], we decided to change the antimicrobial prophylaxis for KT patients from Cefazolin 2 g to Ertapenem 1 g
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