title: Urinary Tract Infections and Surgical Site Infections due to Carbapenem-Resistant Enterobacteriaceae in Renal Transplant.
abstract: BACKGROUND
  Carbapenem-resistant Enterobacteriaceae (CRE) are emerging pathogens. Recent publications have shown that renal transplant recipients are a population at risk for CRE infections. Management of these infections in this population is complex, requiring frequent use of nephrotoxic antimicrobial agents. Differentiating between urinary tract infection (UTI) and surgical site infection (SSI) in renal transplant recipients is sometimes difficult. The aim of this study was to describe CRE UTIs and SSIs in renal transplant recipients and to evaluate the impact of these infections on renal graft and patient survival.
  
  
  RESULTS
  Between January 2010 and October 2015, a total of 428 renal transplants were performed; 25 UTIs and 9 SSIs were identified. Median time between transplantation and diagnosis of CRE infection was 26 days; 29 cases (85.29%) were considered early infections. Of the 34 CRE isolates, 100% were sensitive to amikacin and colistin. Polymyxins were the most commonly used antimicrobial agent (27 cases [79.41%]). Nephrotoxicity was found in 4 (15.38%) of 26 cases. Combination therapy was used in 19 cases (55.88%), with a cure rate of 74%; monotherapy was used in 15 cases (44.11%), with a cure rate of 86%. Among the 25 cases of UTI, the cure rate was 100%, and recurrence occurred in 4 cases (16%). Among the 9 cases of SSI, 7 (77.7%) had negative outcomes (nephrectomy or death).
  
  
  CONCLUSIONS
  We observed that CRE UTIs had a high therapeutic success rate, low recurrence, and low mortality. However, CRE SSIs were associated with high morbidity and mortality, with high graft loss. Polymyxins and aminoglycosides, despite the risk of nephrotoxicity, had little impact on renal graft function, and are thus a safe therapeutic alternative to treat these infections.
authors: Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil; Hospital São José de Doenças Infecciosas - Fortaleza, Ceará, Brazil. Electronic address: bgomesantos@hotmail.com.
authors: B G
authors: BG
authors: Rodrigues Dos Santos
authors: Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil.
authors: E S
authors: ES
authors: Amaral
authors: Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil; Universidade Estadual do Ceará, Fortaleza, Ceará, Brazil.
authors: P F C B C
authors: PF
authors: Fernandes
authors: Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil.
authors: C M C
authors: CM
authors: Oliveira
authors: Universidade Federal do Ceará, Fortaleza, Ceará, Brazil; Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil.
authors: J L N
authors: JL
authors: Rodrigues
authors: Hospital das Clinicas da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors: L V
authors: LV
authors: Perdigão Neto
authors: Hospital Universitário Walter Cantídio, Fortaleza, Ceará, Brazil; Hospital São José de Doenças Infecciosas - Fortaleza, Ceará, Brazil.
authors: E S
authors: ES
authors: Girão
mesh_terms: D000328:Adult; D000617:Aminoglycosides / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011113:Polymyxins / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000188:drug therapy*; D066027:Transplant Recipients; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015780:Carbapenems; D011113:Polymyxins