title: Impact of Gram-negative bloodstream infection on long-term allograft survival after kidney transplantation.
abstract: BACKGROUND
  Gram-negative bloodstream infections (BSI) are common complications after kidney transplantation. In this cohort study, we evaluated the long-term effect of Gram-negative BSI on allograft survival in kidney transplant recipients.
  
  
  METHODS
  Among a cohort of 1820 kidney recipients who were prospectively followed at the Mayo Clinic (Rochester, MN) from January 1, 1996, to December 31, 2007, we identified 120 patients with initial episodes of Gram-negative BSI before allograft failure. Multivariable Cox proportional hazard regression was used to examine the association between Gram-negative BSI, as a time-dependent covariate, and allograft and patient survival.
  
  
  RESULTS
  The median age of kidney recipients was 51 years (interquartile range, 39-61 years) and 58% were men. Among patients with Gram-negative BSI, 75% had a urinary tract source of infection and Escherichia coli was the most common microorganism (50%). Gram-negative BSI after transplantation was independently associated with allograft loss due to allograft failure or death (hazard ratio [HR], 2.52; 95% confidence intervals [CI], 1.83-3.47; P<0.001), allograft failure with death-censored (HR, 3.17; 95% CI, 2.11-4.76; P<0.001) and all-cause mortality (HR, 2.25; 95% CI, 1.55-3.26; P<0.001).
  
  
  CONCLUSIONS
  Prevention and proper management of urinary tract infections in kidney recipients is essential to reduce the risk of more serious complications, including Gram-negative BSI, that are associated with reduced allograft and patient survival.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University of Kentucky, Lexington, KY, USA. majdi.alhasan@uky.edu
authors.forename: Majdi N
authors.initials: MN
authors.lastname: Al-Hasan
authors.forename: Raymund R
authors.initials: RR
authors.lastname: Razonable
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000150:complications*; D005260:Female; D006085:Graft Survival; D016905:Gram-Negative Bacterial Infections / Q000150:complications*; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D014184:Transplantation, Homologous; D014552:Urinary Tract Infections / Q000209:etiology