Risk factors for cephalosporin-resistant (ESBL and AMPc producing) Gram-negative enteric bacilli infection in renal and kidney-pancreas transplant patients

Abstract number: p923

Linares  L., Cervera  C., Marco  F., Martinez  J.A., Perello  R., Cofán   F., Ricart  M.J., Esforzado  N., Oppenheimer  F., Moreno  A.


In our setting, cephalosporin-resistant gram-negative infections in renal and kidney-pancreas (RRPT) patients have been increasing over time. For this reason, we decided to investigate the risk factors for infection with cephalosporin resistant gram-negative bacilli (CRGN) in this group of patients.


From January to July 2005 all patients undergoing RRPT were prospectly evaluated. Pre-transplant detection of ESBL-producing gram-negative bacilli colonization was performed by culture of a rectal swab in MacConkey agar supplemented with cefpodoxime. The variables evaluated were: gender, age, underlying diseases (mellitus diabetes, chronic liver and heart diseases), immunosuppression, acute rejection episodes, surgical reinterventions, need for nephrostomy, use of antibiotics and post-transplant infections.


We included 58 patients, 37 of whom were men (64%), with a mean age of 46 years (SD: 14 years). Forty-eight patients underwent kidney and 10 kidney-pancreas transplantation. The incidence of pre-transplant ESBL-producing gram-negative bacilli bowel colonization was 14% (in all cases Escherichia coli). The incidence of CRGN infection was 15.5% (9 patients), of which 6 were urinary tract infections (3 ESBL E. coli, 2 AMPc C. freundii and 1 ESBL Klebsiella spp) and 3 surgical wound infections (1 ESBL E. coli, 1 AMPc C. freundii and 1 ESBL Klebsiella spp). Three cases developed bacteremia (3 cases E. coli). Underlying diseases, immunosuppressive therapy, prior bacterial infection, use of antibiotics and prior acute rejection were not associated with increased risk of CRGN infection. Previous use of carbapenems did not prevent CRGN infection (p = 1.0). A trend towards the association of ESBL-producing E. coli colonization with ESBL-producing E. coli infection was observed (25 vs 4%;OR 8.0; 95% CI 0.95–67.7; p = 0.09). The need for nephrostomy (OR 11.25; 95% CI 1.6–81.6; p = 0.025) and surgical reintervention (OR 5.6; 95% CI 1.2–24.9; p = 0.03) were associated with higher risk of CRGN infection.


In our setting, the incidence of infection with CRGN and the prevalence of stool colonization with ESBL-producing gram-negative bacilli in RRPT patients was high. Patients requiring major surgical reintervention or those who need nephrostomy are at higher risk of developing CRGN infections. Patients with rectal carriage of ESBL-producing gram-negative bacilli may be at risk for ESBL infections, but a larger study is needed to confirm this results.

Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Location: Oxford, UK
Presentation type:
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