title: The characteristics and outcome of bacteraemia in renal transplant recipients and non-transplant renal patients.
abstract: BACKGROUND
  There is lack of outcome data for bacteraemic patients on specialist renal units. We described demographic, clinical, microbiological data and outcomes for bacteraemic adult renal transplant and non-transplant patients at a London Teaching Hospital. We also assessed the appropriateness of empirical antibiotic policy.
  
  
  METHODS
  From December 2012 to November 2013, demographic, clinical and microbiological data were collected on consecutive patients with bacteraemia on a specialist UK renal unit. Empirical anti-microbial policy, based upon sites of infection, was piperacillin/tazobactam and amikacin, or meropenem for graft pyelonephritis, and vancomycin and gentamicin for suspected central venous catheter (CVC) associated infection.
  
  
  RESULTS
  113 bacteraemic episodes occurred in 83 patients. One patient had two bacteraemic episodes, one on haemodialysis and another after transplantation so appear in both groups. In the non-transplant group, 30-day mortality was 4/59 (6.8 %), more than the renal transplant group, 0/25 (0 %). While graft pyelonephritis was the predominant cause of bacteraemic episodes in renal transplant patients, 25/36 (69.4 %), there were a variety of other causes in the non-transplant group including uncomplicated line associated bacteraemia, 36/77 (46.8 %), complicated line associated bacteraemia, 11/77 (14.3 %) and bacteraemia unrelated to vascular access sites 19/77 (24.7 %). Overall, commonest isolates were Methicillin-sensitive Staphylococcus aureus 20/77 (26.3 %), and Escherichia coli 28/113 (24.8 %). There were no Methicillin-resistant Staphylococcus aureus isolates and, among Enterobacteriaceae, 15/57 (26.3 %) were extended spectrum beta-lactamase producers.
  
  
  CONCLUSIONS
  Death only occurred in the non-transplant renal group. Empirical antibiotic treatment with either piperacillin/tazobactam and amikacin, or meropenem was appropriate for renal transplant recipients as most bacteraemic episodes were secondary to graft pyelonephritis. Vancomycin and gentamicin was appropriate empirical antibiotic treatment for non-transplant patients with CVC associated infections, but not optimal for other sites of infection.
authors.affiliation: Royal London Hospital, Barts Health NHS Trust, 3rd floor Pathology and Pharmacy Building, 80 Newark St., London, E1 2ES, UK. mark.melzer@bartshealth.nhs.uk.
authors.forename: Mark
authors.initials: M
authors.lastname: Melzer
authors.affiliation: SpR in Renal Medicine, Ward 9F, 9th floor, Royal London Hospital, Whitechapel Rd., Whitechapel, London, E1 1BB, UK.
authors.forename: Territa
authors.initials: T
authors.lastname: Santhakumaran
authors.affiliation: Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Welch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008131:London; D008297:Male; D008875:Middle Aged; D066027:Transplant Recipients / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Bacteraemia; Haemodialysis; Outcomes; Renal transplant