Frontiers in Medicine (Feb 2024)

Frequency and impact on renal transplant outcomes of urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species

  • Jakob E. Brune,
  • Michael Dickenmann,
  • Daniel Sidler,
  • Laura N. Walti,
  • Déla Golshayan,
  • Oriol Manuel,
  • Oriol Manuel,
  • Fadi Haidar,
  • Dionysios Neofytos,
  • Aurelia Schnyder,
  • Katia Boggian,
  • Thomas F. Mueller,
  • Thomas Schachtner,
  • Nina Khanna,
  • Stefan Schaub,
  • Stefan Schaub,
  • Caroline Wehmeier,
  • the Swiss Transplant Cohort Study,
  • Patrizia Amico,
  • John-David Aubert,
  • Adrian Bachofner,
  • Vanessa Banz,
  • Sonja Beckmann,
  • Guido Beldi,
  • Christoph Berger,
  • Ekaterine Berishvili,
  • Annalisa Berzigotti,
  • Pierre-Yves Bochud,
  • Sanda Branca,
  • Heiner Bucher,
  • Anne Cairoli,
  • Emmanuelle Catana,
  • Yves Chalandon,
  • Sabina De Geest,
  • Sophie De Seigneux,
  • Michael Dickenmann,
  • Joëlle Lynn Dreifuss,
  • Michel Duchosal,
  • Thomas Fehr,
  • Sylvie Ferrari-Lacraz,
  • Jaromil Frossard,
  • Christian Garzoni,
  • Déla Golshayan,
  • Nicolas Goossens,
  • Fadi Haidar,
  • Jörg Halter,
  • Dominik Heim,
  • Christoph Hess,
  • Sven Hillinger,
  • Hans Hirsch,
  • Patricia Hirt,
  • Linard Hoessly,
  • Günther Hofbauer,
  • Uyen Huynh-Do,
  • Franz Immer,
  • Michael Koller,
  • Andreas Kremer,
  • Christian Kuhn,
  • Bettina Laesser,
  • Frédéric Lamoth,
  • Roger Lehmann,
  • Alexander Leichtle,
  • Oriol Manuel,
  • Hans-Peter Marti,
  • Michele Martinelli,
  • Valérie McLin,
  • Katell Mellac,
  • Aurélia Merçay,
  • Karin Mettler,
  • Nicolas Müller,
  • Ulrike Müller-Arndt,
  • Beat Müllhaupt,
  • Mirjam Nägeli,
  • Graziano Oldani,
  • Manuel Pascual,
  • Jakob Passweg,
  • Rosemarie Pazeller,
  • Klara Posfay-Barbe,
  • David Reineke,
  • Juliane Rick,
  • Anne Rosselet,
  • Simona Rossi,
  • Rössler,
  • Silvia Rothlin,
  • Frank Ruschitzka,
  • Thomas Schachtner,
  • Stefan Schaub,
  • Alexandra Scherrer,
  • Dominik Schneidawind,
  • Aurelia Schnyder,
  • Macé Schuurmans,
  • Simon Schwab,
  • Thierry Sengstag,
  • Federico Simonetta,
  • Jürg Steiger,
  • Guido Stirniman,
  • Ueli Stürzinger,
  • Christian Van Delden,
  • Jean-Pierre Venetz,
  • Jean Villard,
  • Julien Vionnet,
  • Madeleine Wick,
  • Markus Wilhlem,
  • Patrick Yerly

DOI
https://doi.org/10.3389/fmed.2024.1329778
Journal volume & issue
Vol. 11

Abstract

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BackgroundEnterobacterales are often responsible for urinary tract infection (UTI) in kidney transplant recipients. Among these, Escherichia coli or Klebsiella species producing extended-spectrum beta-lactamase (ESBL) are emerging. However, there are only scarce data on frequency and impact of ESBL-UTI on transplant outcomes.MethodsWe investigated frequency and impact of first-year UTI events with ESBL Escherichia coli and/or Klebsiella species in a prospective multicenter cohort consisting of 1,482 kidney transplants performed between 2012 and 2017, focusing only on 389 kidney transplants having at least one UTI with Escherichia coli and/or Klebsiella species. The cohort had a median follow-up of four years.ResultsIn total, 139/825 (17%) first-year UTI events in 69/389 (18%) transplant recipients were caused by ESBL-producing strains. Both UTI phenotypes and proportion among all UTI events over time were not different compared with UTI caused by non-ESBL-producing strains. However, hospitalizations in UTI with ESBL-producing strains were more often observed (39% versus 26%, p = 0.04). Transplant recipients with first-year UTI events with an ESBL-producing strain had more frequently recurrent UTI (33% versus 18%, p = 0.02) but there was no significant difference in one-year kidney function as well as longer-term graft and patient survival between patients with and without ESBL-UTI.ConclusionFirst-year UTI events with ESBL-producing Escherichia coli and/or Klebsiella species are associated with a higher need for hospitalization but do neither impact allograft function nor allograft and patient survival.

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