Cephalosporin-resistant bacilli more likely to infect older recipients.
SAN FRANCISCO—Older age is among the risk factors for infection with gram-negative cephalosporin-resistant bacilli (CRB) in recipients of renal or renal-pancreas transplants, according to Spanish researchers.
Lead investigator Carlos Cervera, MD, professor of infectious diseases at the University of Barcelona, called such infections serious, with the potential of causing prolonged hospital stays. “If we can avoid some of these infections we can prevent morbidity and improve care,” he said. “Urologists need to be vigilant.”
In recent years there has been a steady increase in the number of kidney and kidney-pancreas transplant patients who experience CRB infections. Dr. Cervera and his colleagues studied 349 patients from July 2003 through December 2005. The team examined demographic variables, immunosuppressive treatments, episodes of acute rejection, previous infections, surgical re-intervention, dialysis use, and the need for nephrostomy. Of the 349 patients, 308 (88%) received a kidney and 41 (12%) received a kidney and a pancreas. The mean age was 49.6 years.
All renal transplant patients received surgical prophylaxis with cefazolin, and the kidney-pancreas recipients received cefotaxime plus vancomycin. CRB infections occurred in 32 patients, with an incidence of 9% in the kidney group and 7% in kidney-pancreas group, the investigators reported here at the 46th annual Interscience Conference on Antimicrobial Agents and Chemotherapy. The source of the infection was urinary in 81% of cases and surgical in the rest. In addition, 25% of patients had bacteremia. The most frequent microorganisms were Escherichia coli (17 cases), Klebsiella spp. (10 cases) and Citrobacter spp. (5 cases).
The patients with CRB infections were older than those without the infections (57 vs. 49 years). Age and the need for post-transplant dialysis and nephrostomy were independent risk factors for CRB infections.
Few studies have looked at this issue, Dr. Cervera observed, adding that identifying risk factors could result in more effective prevention. “We only have a limited number of drugs for these infections, specifically aminoglycosides and carbapenems, and they are only available for intravenous therapy. This can lead to life-threatening toxicity and costly, prolonged hospital stays. Further studies are required for evaluating preventive strategies for the control of multi-resistant bacteria infections among kidney transplant recipients.”