Risk factors for infection with extended-spectrum and AmpC beta-lactamase-producing gram-negative rods in renal transplantation.
Increasing prevalence of infections caused by multiresistant gram-negative enteric bacilli due to synthesis of extended-spectrum beta-lactamase (ESBL) or to desrepressed chromosomic AmpC beta-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 beta-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 multiresistant gram-negative enteric bacilli infections. The incidence of ESBL-producing and desrepressed AmpC beta-lactamase gram-negative enteric bacilli infection in our population was high. These infections are associated with significant morbidity after renal transplantation.
Linares
L
L
Services of Infectious Diseases, University of Barcelona, Barcelona, Spain.
Cervera
C
C
Cofán
F
F
Lizaso
D
D
Marco
F
F
Ricart
M J
MJ
Esforzado
N
N
Oppenheimer
F
F
Campistol
J M
JM
Moreno
A
A
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000378:metabolism*; D015331:Cohort Studies; D018432:Drug Resistance, Multiple; D004926:Escherichia coli / Q000302:isolation & purification / Q000378:metabolism; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000378:metabolism; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D007709:Klebsiella / Q000302:isolation & purification / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C048795:AmpC beta-lactamases; D001618:beta-Lactamases