AUTHOR=Brune Jakob E. , Dickenmann Michael , Sidler Daniel , Walti Laura N. , Golshayan Déla , Manuel Oriol , Haidar Fadi , Neofytos Dionysios , Schnyder Aurelia , Boggian Katia , Mueller Thomas F. , Schachtner Thomas , Khanna Nina , Schaub Stefan , Wehmeier Caroline , the Swiss Transplant Cohort Study , Amico Patrizia , Aubert John-David , Bachofner Adrian , Banz Vanessa , Beckmann Sonja , Beldi Guido , Berger Christoph , Berishvili Ekaterine , Berzigotti Annalisa , Bochud Pierre-Yves , Branca Sanda , Bucher Heiner , Cairoli Anne , Catana Emmanuelle , Chalandon Yves , De Geest Sabina , De Seigneux Sophie , Dickenmann Michael , Lynn Dreifuss Joëlle , Duchosal Michel , Fehr Thomas , Ferrari-Lacraz Sylvie , Frossard Jaromil , Garzoni Christian , Golshayan Déla , Goossens Nicolas , Haidar Fadi , Halter Jörg , Heim Dominik , Hess Christoph , Hillinger Sven , Hirsch Hans , Hirt Patricia , Hoessly Linard , Hofbauer Günther , Huynh-Do Uyen , Immer Franz , Koller Michael , Kremer Andreas , Kuhn Christian , Laesser Bettina , Lamoth Frédéric , Lehmann Roger , Leichtle Alexander , Manuel Oriol , Marti Hans-Peter , Martinelli Michele , McLin Valérie , Mellac Katell , Merçay Aurélia , Mettler Karin , Müller Nicolas , Müller-Arndt Ulrike , Müllhaupt Beat , Nägeli Mirjam , Oldani Graziano , Pascual Manuel , Passweg Jakob , Pazeller Rosemarie , Posfay-Barbe Klara , Reineke David , Rick Juliane , Rosselet Anne , Rossi Simona , Rössler , Rothlin Silvia , Ruschitzka Frank , Schachtner Thomas , Schaub Stefan , Scherrer Alexandra , Schneidawind Dominik , Schnyder Aurelia , Schuurmans Macé , Schwab Simon , Sengstag Thierry , Simonetta Federico , Steiger Jürg , Stirniman Guido , Stürzinger Ueli , Van Delden Christian , Venetz Jean-Pierre , Villard Jean , Vionnet Julien , Wick Madeleine , Wilhlem Markus , Yerly Patrick TITLE=Frequency and impact on renal transplant outcomes of urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species JOURNAL=Frontiers in Medicine VOLUME=11 YEAR=2024 URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2024.1329778 DOI=10.3389/fmed.2024.1329778 ISSN=2296-858X ABSTRACT=Background

Enterobacterales 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.

Methods

We 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.

Results

In 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.

Conclusion

First-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.