Bacterial and fungal infections in the early post-transplant period after kidney transplantation: etiological agents and their susceptibility.
BACKGROUND
Infections remain serious complications in solid-organ transplant recipients, despite professional medical care, the introduction of new immunosuppressive drugs, and treatment that decreases the risk of infections.


METHODS
The study covered 295 adult patients undergoing kidney transplantation (KTx) between September 2001 and December 2007. All the patients were followed prospectively for infections from the KTx date and during the first 4 weeks after surgery. Samples of clinical materials were investigated for microbiological cultures. The microorganisms were cultured and identified in accordance with standard bacteriological procedures. Susceptibility testing was carried out through the use of Clinical and Laboratory Standards Institute procedures.


RESULTS
From 295 KTx recipients, 1073 clinical samples were taken for microbiological examination. Positive cultures were 26.9% (n = 289) of all samples tested; 525 strains were collected. Gram-positive bacteria were isolated in 52.2% (n = 274), Gram-negative bacteria were isolated in 40.8% (n = 214), and fungal strains were isolated in 7% (n = 37). Urine specimens (n = 582) were obtained from 84.5% of 245 recipients during the first month after transplantation. Among the isolated bacterial strains (n = 291), the most common were Gram-negative bacteria (56.4%). Gram-positive bacteria comprised 35.7%; fungal strains were found in 23 cases (7.9%). In surgical site specimens (n = 309), Gram-positive bacteria (72.1%) were the most common. Gram-negative bacteria comprised 24.4%. In blood specimens (n = 138), Gram-positive bacteria (81.6%) were the most common. Gram-negative bacteria comprised 15.8%; fungi were isolated in 2.6%. In respiratory tract specimens (n = 13), among the isolated bacterial strains (n = 8), the most common were Gram-positive bacteria (57.1%). Gram-negative bacteria comprised 14.3%; fungi were isolated in 28.6%.


CONCLUSIONS
Urine samples were predominantly positive after KTx. Our study showed Gram-positive bacteria in 52.2% after kidney transplantation. The proportion of isolates of multi-drug-resistant bacterial strains (MRCNS, vancomycin-resistant strains, high-level aminoglycoside-resistant strains, extended-spectrum beta-lactamase producers, and high-level aminoglycoside-resistant strains) was increased. These data indicate the need for strict adherence to infection control procedures in these patients.
Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland. Electronic address: dkawecki@o2.pl.
D
D
Kawecki
Department of General Surgery and Transplantation, Medical University of Warsaw, Warsaw, Poland.
M
M
Wszola
Department of General Surgery and Transplantation, Medical University of Warsaw, Warsaw, Poland.
A
A
Kwiatkowski
Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
A
A
Sawicka-Grzelak
Department of Transplant Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
M
M
Durlik
Department of Immunology, Transplantology, and Internal Diseases, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland.
L
L
Paczek
Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
G
G
Mlynarczyk
Department of General Surgery and Transplantation, Medical University of Warsaw, Warsaw, Poland.
A
A
Chmura
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018432:Drug Resistance, Multiple; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011446:Prospective Studies