Distribution Of Bacteria,Resistance Characteristics Of MDR Bacteria And Risk Factors Of MDR Among Kidney Transplant Recipients With Infection

Background and ObjectiveInfection ranks the most common complication after kidney transplantation and threatens outcomes of kidney transplantation patients.The retrospective study aimed to explore the microbiological profile of infection,assess bacteria resistance and identify risk factors for multidrug-resistant(MDR)bacterial infection among kidney transplantation recipients(KTR)to further prevent and improve the management of post-transplant infections and to provide a clinical basis for the rational use of antibiotics against MDR bacteria.Materials and MethodA retrospective study of KTR in the past13 years during January 2007 and December 2019 was performed.We studied the demographic characteristic,distribution of microorganisms,resistance rate of pathogenic bacteria and the risk factor of MDR bacterial infection.ResultsTotally,119 recipients experienced 142 episodes of culture-proven infections.Among the 214 strains of microorganisms,the Gram-negative and Gram-positive bacteria were 146 and 47 strains,respectively.Besides that 110(57.0%)strains were MDR bacteria.1.The distribution of pathogens after kidney transplantation surgery:the peak stage of pathogen detection was within 3 months postoperative with Pseudomonas aeruginosa and Escherichia coli being the most common bacteria within 6 months and after 6 months after kidney transplantation,respectively;Overall,Escherichia coli was the most common bacteria.Within 3 months postoperative was the high prevalence stage of infection,and urinary tract infection was the most common site of infection.For urinary tract infections,non-fermentative bacteria were the main causative organisms within 6 months after kidney transplantation,while Enterobacteriaceae were the main causative organisms after 6 months.For pulmonary infections,non-fermentative bacteria were the most common pathogens in their postoperative period.2.MDR bacteria after kidney transplantation:More than 90%of MDR Enterobacteriaceae were resistant to ampicillin,cefazolin and SMZ,while they were most susceptible to imipenem,followed by amikacin and piperacillin sulbactam with resistance rate of 4%,13%and 23.3%,respectively.All of MDR non-fermentative bacteria were resistant to ampicillin,levofloxacin,cefazolin and aztreonam,and only about 33.3%of them were resistant to amikacin.MDR Enterococci were resistant to high concentrations of gentamicin,ampicillin and ciprofloxacin,all of which were more than 94%,while the highest susceptibility to linezolid and vancomycin were both more than 94%;more than 85%of MDR staphylococci were resistant to erythromycin.On the other hand,they were totally sensitive to vancomycin and linezolid,followed by rifampicin,with resistant rate of 7.1%.3.Changes in the detection rate and resistance of MDR bacteria after kidney transplantation:the overall detection rate of MDR bacteria(P=0.02)and the detection rate of MDR Gram-negative bacilli(P=0.04)after kidney transplantation showed an increasing trend year by year;the resistance rate of MDR Gram-negative bacilli to gentamicin(P=0.023)showed a decreasing trend.4.Risk factors for MDR bacterial infections after kidney transplantation:female(OR=3.597,95%CI=1.564-8.272,P=0.003),pathogen more than 1 species(OR=3.957,95%CI=1.505-10.496,P=0.003)and 1 months after kidney transplantation(OR=3.158,95%CI=1.401-7.122,P=0.006)were independent risk factors for MDR bacterial infections.Conclusion1.Within 3 months postoperative was a high incidence of infection,and E.coli was the most common pathogen after kidney transplantation,urinary tract infection was the most frequent infection.2.Imipenem was preferred for MDR Enterobacteria infections,while piperacillin-sulbactam and amikacin could also be used as alternative treatment options.For MDR Gram-positive cocci,vancomycin and linezolid were the preferred options,but for MDR staphylococci rifampicin could also be used as an alternative option.3.The detection rate of MDR bacteria after kidney transplantation showed an increasing trend,but the MDR Gram-negative bacilli showed a decreasing trend for gentamicin resistance4.Women,pathogens more than 1 species and 1 month after kidney transplantation were independent risk factors for MDR bacterial infections.