P Weber, P Braß, J Jäger, L Jacquet, S Jansen, A Gäckler, C Jürgens, J Reinold, U Eisenberger, P-M Rath, A Kribben, O Witzke, H Rohn
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引用次数: 0
Abstract
Purpose: Urinary tract infections (UTIs) are common complications after kidney transplantation (KT), often resulting in severe outcomes like acute graft failure and sepsis. Factors such as diabetes, age, sex, and type of transplantation significantly influence disease progression. Rising antibiotic resistance complicates treatment, emphasizing the importance of Antimicrobial Stewardship (AMS), particularly during the post-transplant immunosuppression phase. Recent changes in treatment protocols, including a shift away from treating asymptomatic bacteriuria and modifications in antibiotic prescribing, highlight the need for updated resistance trend analyses.
Methods: This retrospective study at the University Hospital Essen analyzed urine samples from kidney transplant outpatients from 2013 to 2022. Pathogen identification and resistance testing focused on common UTI pathogens, including Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, Enterococcus faecium, and Enterococcus faecalis. Data on antibiotic prescriptions were sourced from the North Rhine Association of Statutory Health Insurance since 2017.
Results: Out of 10,508 urine samples collected from 6962 patients, bacterial growth was detected in 4126 samples (39%). Escherichia (E.) coli was the most frequent pathogen (41%). Klebsiella spp., which accounted for 11.7% of all pathogens, showed increasing resistance to piperacillin/tazobactam and ceftazidime. Resistance rates Enterococcus faecalis showing a significant decline in levofloxacin (100% resistance in 2014 in all isolates, compared to 2% in 2022). An increasing concern in our cohort is the prevalence of Extended Spectrum Beta-Lactamase (ESBL)-producing Gram-negative pathogens, particularly Klebsiella spp., which are being detected with greater frequency. In our center, we have observed a significant increase in the use of oral antibiotics recommended for first-line therapy. This shift is attributed to updated guidelines and therapeutic recommendations. Consequently, oral cephalosporins are now rarely used due to their low bioavailability.
Conclusion: The study highlights the importance of ongoing surveillance to address antibiotic resistance in KT recipients. Increasing resistance in pathogens like Klebsiella spp. necessitates new antimicrobial strategies. Findings should inform future guidelines to preserve antibiotic effectiveness and improve therapeutic outcomes in this vulnerable patient population.
期刊介绍：
Infection is a journal dedicated to serving as a global forum for the presentation and discussion of clinically relevant information on infectious diseases. Its primary goal is to engage readers and contributors from various regions around the world in the exchange of knowledge about the etiology, pathogenesis, diagnosis, and treatment of infectious diseases, both in outpatient and inpatient settings.
The journal covers a wide range of topics, including:
Etiology: The study of the causes of infectious diseases.
Pathogenesis: The process by which an infectious agent causes disease.
Diagnosis: The methods and techniques used to identify infectious diseases.
Treatment: The medical interventions and strategies employed to treat infectious diseases.
Public Health: Issues of local, regional, or international significance related to infectious diseases, including prevention, control, and management strategies.
Hospital Epidemiology: The study of the spread of infectious diseases within healthcare settings and the measures to prevent nosocomial infections.
In addition to these, Infection also includes a specialized "Images" section, which focuses on high-quality visual content, such as images, photographs, and microscopic slides, accompanied by brief abstracts. This section is designed to highlight the clinical and diagnostic value of visual aids in the field of infectious diseases, as many conditions present with characteristic clinical signs that can be diagnosed through inspection, and imaging and microscopy are crucial for accurate diagnosis. The journal's comprehensive approach ensures that it remains a valuable resource for healthcare professionals and researchers in the field of infectious diseases.
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