Unit:
Faculty of MedicineLibrary of the School of Health Sciences
Author:
Tsikala-Vafea Maria
Dissertation committee:
Γεώργιος Δαΐκος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ιωάννης Μπολέτης, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μιχαήλ Σαμάρκος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ευάγγελος Χολόγκιτας, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Βασιλική-Αναστασία Σύψα, Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μήνα Ψυχογυιού (Επιβλέπον μέλος ΔΕΠ), Αναπληρώτρια Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σμαράγδη Μαρινάκη, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Επίπτωση της βακτηριαιμίας από gram αρνητικά βακτήρια σε ασθενείς με μεταμόσχευση νεφρού-Παράγοντες κινδύνου και θνητότητα
Translated title:
Gram negative bloodstream infection incidence in kidney transplant patients-Risk factors and mortality
Summary:
Kidney transplant recipients are at increased risk for infections. The aims of this study were: i) to estimate the incidence of bloodstream infections (BSI) caused by gram negative bacteria in kidney transplant recipients, ii) to identify risk factors for BSI by multidrug resistant gram negative bacteria, and iii) to identify predictors for unfavorable outcome (death or loss of transplanted kidney).
We conducted a retrospective cohort study at the renal transplant unit (RTU) of a tertiary care hospital located in Athens, Greece, between September 2008 and September 2018. Kidney transplant recipients with gram negative BSIs were identified from the microbiology laboratory electronic records. Patient-, infection-, and treatment-related factors were extracted from the medical records.
During the study period, 1962 kidney transplant recipients were followed at the RTU of the hospital. A total of 195 BSI episodes were recorded in 182 patients (male/female=97/85), with median (25th, 75th) patient age 57.2 (44, 64.9) years. The incidence of BSI was 1.393/100 patient-years. Escherichia coli was the most common cause (63.7 %, 116/182), while the most common source of infection was urinary tract (70.9%, 129/182). 19.2% (35/182) of BSIs were caused by multidrug resistant organisms (MDR). 6% (11/182) of patients died in the hospital and 2.2% (4/182) were subjected to nephrectomy due to the BSI. Multivariate logistic regression showed that diabetes mellitus [odds ratio (OR) 8.114; 95% confidence interval (CI) 1.309-50.318], Pseudomonas aeruginosa BSI (OR 46.113; CI 3.850-552.336) and septic shock (OR 46.713; CI 1.672-1304.850) were independent risk factors for unfavorable outcome. Previous antibiotic use (OR 8.212; CI 2.050-32.890) and previous stay in the Intensive Care Unit (OR 34.191; CI 1.601-730.161) were independent risk factors for MDR BSIs.
BSIs in kidney transplant recipients are a critical factor of morbidity and mortality. Recognizing the risk factors for unfavorable outcome and for emergence of MDR bacteria could offer a significant advantage in early diagnosis and appropriate treatment.
Main subject category:
Health Sciences
Keywords:
Bloodstream infection, Kidney transplant recipients, Multidrug resistant, Mortality
Number of references:
257
