title: Blood stream infections in renal transplant recipients: a single-center study.
abstract: BACKGROUND
  Bacteremias among renal transplant recipients are more frequent as a result of immunosuppression. They are considered extremely high-risk because they are correlated with decreased allograft and recipient survival.
  
  
  METHODS
  All episodes of bacteremia among renal transplant recipients were documented following review of medical records, from January 2010 to May 2013.
  
  
  RESULTS
  In total 26 episodes of bacteremia were observed in 22 patients. Gram negative bacteremia was identified in 73% (19/26) cases. Pathogens according to their frequency were the following Escherichia coli (6/26, 23%), Klebsiella pneumonia (5/26, 19%), Pseudomonas aeruginosa (3/26, 11%), Staphylococcus epidermidis (3/26, 11%), Acinetobacter baumanni (2/26, 7.7%), Enterococcus faecalis (2/26, 7.7%). The first trimester post renal transplantation 18 episodes (69%) of bacteremia were presented that were not correlated to indwelling urinary catheter or stent. Positive urinary culture with the same pathogen was recognized in 13 patients. All recipients manifested fever, eight recipients had leucocytosis and three cases were complicated by septic shock. Immediate resuscitation with intravenous fluids and non-nephrotoxic antibiotic regimen was initiated. Acute renal allograft dysfunction (defined as an increase in serum creatinine more than 0.5 mg/dL from baseline) was observed in five patients and was restored following infection resolution.
  
  
  CONCLUSIONS
  Increased prevalence of bacteremia in renal transplant recipients is attributed to immunosuppression and usually bacteremic episodes follow urinary tract infection. The commonest pathogens are Gram negative bacteria with E. coli the most frequent. Early detection and proper management are important as bacteremia affects renal allograft and recipient survival.
authors.affiliation: First Department of Surgery - Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Daskalaki
authors.affiliation: First Department of Surgery - Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: M
authors.initials: M
authors.lastname: Koukoulaki
authors.affiliation: First Department of Surgery - Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Bakalis
authors.affiliation: Fifth Department of Internal Medicine - Division of Infectious Diseases, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: V
authors.initials: V
authors.lastname: Papastamopoulos
authors.affiliation: Department of Microbiology, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Belesiotou
authors.affiliation: Department of Microbiology, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Perivolioti
authors.affiliation: Fifth Department of Internal Medicine - Division of Infectious Diseases, Evangelismos General Hospital of Athens, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Skoutelis
authors.affiliation: First Department of Surgery - Transplant Unit, Evangelismos General Hospital of Athens, Athens, Greece. Electronic address: spdrakopoulos@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Drakopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents