Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae-Related Urinary Tract Infection in Kidney Transplant Recipients: Risk Factors, Treatment, and Long-Term Outcome

Background:Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) has risen in kidney transplant (KT) patients, with no long-term data so far on graft function or survival. Methods:KT patients with ESBL-E-positive urine culture were retrospectively analyzed regarding initial adequate antimicrobial therapy, recurrent infection, transplant function, and survival compared with an ESBL-E-negative KT control cohort. Results:ESBL-E-positive KT patients (n = 93) were older (55.5 +/- 16.1 vs 49.5 +/- 16.8 y; P = .001), presented with higher trough levels of cyclosporine and tacrolimus (121 +/- 71 vs 102 +/- 32 ng/mL [P = .04]; and 7.9 +/- 3.3 vs 7.0 +/- 2.3 ng/mL [P = .04], respectively), higher dosages of mycophenolate (1,533 +/- 670 vs 1,493 +/- 436; P = .001), and more acute rejection episodes within 3 months before diagnosis (12.9% vs 0.8%; P < .0001) compared with control subjects (n = 591). Five-year patient survival was superior in control subjects compared with ESBL-E-positive patients (91.2% vs 83.5%; P = .034) but long-term graft function was similar. Hospitalization rates were higher in patients presenting with ESBL-E-related urinary tract infection (UTI) compared with control subjects with ESBL-E-negative UTI (60.3% vs 31.3%; P = .002) but 5-year graft survival was superior in patients presenting with ESBL-E-related UTI (88.6% vs 69.8%; P = .035) compared with control subjects with ESBL-E-negative UTI. Recurrence rates were similar in patients with or without ESBL-E-related UTI. Initial antibiotic treatment was adequate in 41.2% of patients presenting with ESBL-E-related urosepsis, resulting in a reevaluation of antibiotic stewardship in our clinic. Conclusions:ESBL-E detection in general was associated with higher mortality, but graft survival in patients with ESBL-E-related UTI was significantly better compared with ESBL-E-negative UTI.