Urinary Tract Infections and Surgical Site Infections due to Carbapenem-Resistant Enterobacteriaceae in Renal Transplant

被引:15
作者
Rodrigues dos Santos, B. G. [1 ,2 ,3 ,6 ]
Amaral, E. S., Jr. [4 ]
Fernandes, P. F. C. B. C. [2 ,4 ]
Oliveira, C. M. C. [2 ]
Rodrigues, J. L. N. [1 ,2 ]
Perdigao Neto, L. V. [5 ]
Girao, E. S. [2 ,3 ]
机构
[1] Univ Fed Ceara, Rua Prof Costa Mendes 1608,5o Andar, Fortaleza, Ceara, Brazil
[2] Hosp Univ Walter Cantidio, Fortaleza, Ceara, Brazil
[3] Hosp Sao de Jose Doencas Infecciosas Fortaleza, Fortaleza, Ceara, Brazil
[4] Univ Estadual Ceara, Fortaleza, Ceara, Brazil
[5] Univ Sao Paulo, Hosp Clin, Sao Paulo, SP, Brazil
[6] Rua Coronel Alves Teixeira 1480,Apto 501, BR-60135208 Fortaleza, Ceara, Brazil
关键词
ANTIMICROBIAL SURVEILLANCE PROGRAM; KLEBSIELLA-PNEUMONIAE; RISK-FACTORS; K; PNEUMONIAE; RECIPIENTS; MORTALITY; KIDNEY; EPIDEMIOLOGY; OUTCOMES; IMPACT;
D O I
10.1016/j.transproceed.2016.05.005
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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.
引用
收藏
页码:2050 / 2055
页数:6
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