@article{3120460,
    title = "Bloodstream infections by gram-negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome",
    author = "Tsikala-Vafea, M. and Basoulis, D. and Pavlopoulou, I. and Darema, M. and Deliolanis, J. and Daikos, G.L. and Boletis, J. and Psichogiou, M.",
    journal = "Transplant Infectious Disease",
    year = "2020",
    volume = "22",
    number = "6",
    publisher = "Blackwell Publishing Inc.",
    issn = "1398-2273, 1399-3062",
    doi = "10.1111/tid.13442",
    keywords = "amikacin;  antibiotic agent;  carbapenemase;  cefotaxime;  ceftazidime;  cephalosporin derivative;  ciprofloxacin;  clavulanic acid;  corticosteroid;  cyclosporine;  hypertensive agent;  imipenem;  immunosuppressive agent;  infusion fluid;  mammalian target of rapamycin inhibitor;  meropenem;  metallo beta lactamase;  mycophenolate mofetil;  netilmicin;  piperacillin;  piperacillin plus tazobactam;  proton pump inhibitor;  tacrolimus;  tigecycline, adult;  aged;  antibiotic resistance;  antibiotic sensitivity;  antibiotic therapy;  Article;  bloodstream infection;  cohort analysis;  controlled study;  death;  diabetes mellitus;  dialysis;  Escherichia coli infection;  female;  Gram negative infection;  Greece;  human;  immunosuppressive treatment;  incidence;  infection risk;  kidney transplantation;  major clinical study;  male;  middle aged;  multidrug resistance;  nephrectomy;  nonhuman;  postoperative infection;  priority journal;  Pseudomonas aeruginosa;  Pseudomonas infection;  retrospective study;  risk factor;  septic shock;  urinary tract infection;  bacteremia;  graft recipient;  Gram negative bacterium;  Gram negative infection;  sepsis, Bacteremia;  Female;  Gram-Negative Bacteria;  Gram-Negative Bacterial Infections;  Greece;  Humans;  Incidence;  Kidney Transplantation;  Male;  Middle Aged;  Retrospective Studies;  Risk Factors;  Sepsis;  Transplant Recipients",
    abstract = "Background: Kidney transplant recipients (KTRs) are at increased risk of infections. Methods: The aims of this study were to describe the incidence of bloodstream infections (BSIs) by gram-negative bacteria in a cohort of KTRs, the risk factors for BSI due to multi-drug–resistant (MDR) gram-negative bacteria, and the predictors for unfavorable outcome, defined as death or nephrectomy or return to dialysis, within 30 days from BSI. We conducted a retrospective cohort study at the renal transplant unit of a tertiary care hospital in Athens, Greece. Results: In a total of 1962 KTRs, we recorded 195 BSI episodes in 182 single patients (male/female = 97/85), with a median (interquartile range) age of 57.2 (44-64.9) years. The incidence was 1.393/100 patient-years. The most common source of infection was urinary tract (70.9%), and Escherichia coli (63.7%) was the most common pathogen. 19.2% of the infecting organisms were MDR; previous antibiotic use (OR 8.2; CI 2.1-32.9) and previous stay in the intensive care unit (OR 34.2; CI 1.6-730.2) were associated with MDR BSIs. 6% of patients died, and 2.2% underwent nephrectomy, while no patients had to return to dialysis. Diabetes mellitus (OR 8.1; 95% CI 1.3-50.3), Pseudomonas aeruginosa BSI (OR 46.1; 95% CI 3.9-552.3), and septic shock (OR 46.7; 95% CI 1.7-1304.9) were independent predictors of unfavorable outcome. Conclusion: Bloodstream infections in KTRs have a significant impact on allograft and patients outcome. © 2020 Wiley Periodicals LLC"
}