Objective: The epidemiology of a bloodstream infection (BSI) in a renal transplant recipient (RTR) and the resistance pro-files of the isolates provide important guidance for empirical treatment.
Materials and Methods: The medical records of RTRs from a single university hospital during the period of January 2000 to January 2016 were retrospectively evaluated for the presence of a BSI. Blood culture and antibiotic susceptibility results were reviewed in addition to demographic and clinical data. The distribution of causative microorganisms and risk factors for mortality in RTRs with a BSI were analyzed.
Results: In all, 74 BSIs and 76 distinct bacteria were observed in 56 (8%) of 702 RTRs. The mean age of the patients was 43±14 years; 55% were female, and 54% of the transplants were from living donors. Gram-negative bacteria, predomi-nantly Enterobacteriaceae, were the most common (71%) pathogen. One-fifth of all BSIs occurred within the first month of transplantation. Among those that were Gram-positive, there were 5 coagulase-negative staphylococci and 8 Staphylococcus aureus BSIs. The rate of resistance to extended-spectrum β-lactamase, quinolone, and trimethoprim-sulfamethoxazole in Gram-negative enteric bacilli (GNEB) was 36%, 34%, and 50%, respectively. All of the GNEB were susceptible to carbapen-ems and amikacin. The overall mortality rate was 25%. The median length of time from the onset of BSI to death was 8 days (minmax: 246 days). The urinary tract was the primary source of infection in 53% of the patients. Delayed graft function significantly increased the mortality risk among RTR patients with a BSI.
Conclusion: Gram-negative bacteria were the leading cause of BSIs and demonstrated high resistance rates, and the most common site of infection was the urinary tract. Awareness of local epidemiology and resistance profiles will enable tailored treatment strategies to manage a BSI in RTRs.