Distribution and Antibiotic Susceptibility Pattern of Multidrug-Resistant Bacteria and Risk Factors Among Kidney Transplantation Recipients with Infections Over 13 Years: A Retrospective Study

Abstract

Background: Infection ranks as the most common complication after kidney transplantation (KT) and threatens outcomes of kidney transplantation recipients (KTR). This study aimed to investigate the microbiological profile of infection, assess bacterial resistance and identify risk factors for multidrug-resistant (MDR) bacterial infection among KTR. Methods: During the study period, 866 recipients underwent kidney transplant surgery. We studied the distribution of pathogens, resistance rate of MDR bacteria and the risk factors of MDR bacterial infection. Results: Totally, 214 species of pathogens (110 species were MDR bacteria) were isolated in 119 KTR. Escherichia coli (E. coli) was the most common bacteria of the infection. MDR extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) were most resistant to ampicillin, cefazolin, ciprofloxacin and complex sulfamethoxazole, while quite sensitive to imipenem, amikacin and piperacillin/tazobactam (PIT). All MDR gram-positive bacteria were quite sensitive to linezolid and vancomycin, except that MDR Staphylococcus was also susceptible to rifampicin. Female gender (OR = 3.497, 95% CI = 1.445–8.467, P = 0.006), pathogen types > 1 (OR = 3.832, 95% CI = 1.429–10.273, P = 0.008) and postoperative time < 3 months (OR = 0.331, 95% CI = 0.137–0.799, P = 0.014) were independent risk factors for MDR bacterial infection. Conclusion: PIT and amikacin may be an alternative choice of ESBL-E infection. Rifampicin can also be prescribed for MDR Staphylococcus infection. MDR bacterial infection was associated with female gender, pathogen types more than 1 and 3 months postoperative period.