Assessment of Posttransplant Bacteremia Caused by Extended-Spectrum Beta-Lactamase–Producing Gram-Negative Bacteria Among Kidney Transplant Recipients

Abstract

Background: Extended-spectrum beta-lactamase–producing gram-negative rods (ESBL-GNR) are a rising cause of bacteremia in kidney transplant recipients (KT). The study purpose was to examine patient mortality, allograft survival, estimated glomerular filtration rate (eGFR) at the end of 1 year, and readmission rates while looking at treatment strategies among KTs with ESBL-GNR and non–ESBL-GNR bacteremia at our institution. Methods: This study was a retrospective, cohort analysis of KTs with gram-negative bacteremia from January 1, 2020, to December 31, 2021. The primary outcome of the study was mortality. Patient outcomes were assessed for 365 days after positive blood cultures. Results: The study included 63 patients. Of these, 18 (29%) patients had bacteremia caused by an ESBL-GNR and 45 (71%) patients had bacteremia caused by a non–ESBL-GNR. Patient survival at 90 days was 94% in the ESBL-GNR group and 96% in the non–ESBL-GNR group. Ciprofloxacin was the most common antimicrobial therapy at discharge (68.9%) in the non–ESBL-GNR group whereas ertapenem was the most common in the ESBL-GNR group (44.5%). Median eGFR at discharge was 41 mL/min/1.73 m2 in the ESBL-GNR group and 48 mL/min/1.73 m2 in the non–ESBL-GNR group. Ninety-day readmission occurred in 9 (50%) ESBL-GNR patients and 14 (32%) non–ESBL-GNR patients. None of the above comparisons are statistically significant (p > 0.05). Eleven (61%) ESBL-GNR and 2 (4%) non–ESBL-GNR patients used outpatient parenteral antimicrobial therapy (p < 0.001). Conclusions: Among KTs with ESBL-GNR bacteremia, no significant difference was detected in mortality or allograft function compared to non–ESBL-GNR bacteremia.