Carbapenem-resistant Enterobacteriaceae among kidney transplant recipients - insights on the risk of acquisition and CRE infection

• Published in: Infectious diseases (London, England) Vol. 53; no. 6; pp. 430 - 439
• Main Authors: Freire, Maristela P., Carvalho, Laina B., Reusing, Jose Otto, Spadão, Fernanda, Lopes, Max Igor B. F., Nahas, William C., David-Neto, Elias, Pierrotti, Ligia C.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 03.06.2021
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Carbapenem-Resistant Enterobacteriaceae; Carbapenems - pharmacology; Case-Control Studies; delay of graft function; diabetes nephropathy; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - epidemiology; Humans; Kidney Transplantation; lymphopenia; Polymyxin resistance; rejection; Risk Factors; Transplant Recipients; urinary tract infection; diabetes nephropathy; Polymyxin resistance; delay of graft function; lymphopenia; rejection; urinary tract infection
• DOI: 10.1080/23744235.2021.1887511
• ISSN: 2374-4235; 2374-4243

Kidney transplant recipients are a risk group for carbapenem-resistant Enterobacteriaceae infection. This study aimed to identify risk factors for CRE acquisition and infection among kidney transplant recipients. We conducted a case-control study; we defined the case as kidney transplant recipient with positive culture for carbapenem-resistant Enterobacteriaceae identified between January 2010 and February 2019. Controls were chosen among kidney transplant recipients hospitalized in the same period of cases (1:2). Surveillance culture for carbapenem-resistant Enterobacteriaceae was performed at admission and weekly during hospital stay. The risk factors analysis for carbapenem-resistant Enterobacteriaceae infection was performed among patients colonized by these bacteria. We identified 331 patients colonized with carbapenem-resistant Enterobacteriaceae; The median time from transplantation to first carbapenem-resistant Enterobacteriaceae positive culture was 42 days (range from 3 to 7399 days); 125(37.8%) patients developed infection; the most common site was urinary tract. Risk factors for carbapenem-resistant Enterobacteriaceae acquisition were recipient age >45-year, diabetes nephropathy, donor age >55-year, ureteral stent at kidney transplantation, delay of graft function, median lymphocytes count <800cells/mm 3 , and acute cellular rejection. Risk factors for carbapenem-resistant Enterobacteriaceae infection were recipient age at CRE acquisition >50-year; median lymphocytes count ≤700 cells/mm 3 , carbapenem use, and colonization by polymyxin-resistant strain. Patients colonized by polymyxin and carbapenem resistant Enterobacteriaceae strain who used carbapenem had a 93.8% probability of developing infection by this agent. Carbapenem-resistant Enterobacteriaceae acquisition after kidney transplant is related to graft conditions, immunosuppression degree. Among carbapenem-resistant Enterobacteriaceae colonized patients, special attention is needed for those harbouring polymyxin-resistant strains.