Enterococcal Infections (EI) in Kidney Transplant (KT) Recipients – a Four Year Retrospective Review
Methods: A retrospective cohort study was done of EI in patients who received a KT between 2009 and 2012 at Henry Ford Hospital, Detroit Michigan. Clinical information including demographics, clinical, laboratory, treatment and outcome data were collected. Frequency analysis was performed using chi-square test for dichotomous variables and student’s t test for continuous variables. Logistic regression analysis was done of risk factors that could contribute to adverse outcomes resulting from EI namely, clinical failure, graft loss or death. Clinical failure was defined as lack of clinical resolution of infection or microbiological eradication after ≥ 7 days of specific antibiotic therapy.
Results: The incidence of Enterococcus isolated in our cohort of 478 KT recipients, followed up for a minimum of 1 year after KT, was 16.1 per 100 (77/478). Of the isolates 47% were E. faecalis, 28% E. faecium and 42% vancomycin-resistant enterococci. In 10/77 (13%) patients the enterococci represented colonization and were not treated. EI in the remaining 67 patients developed at a median of 30 days after KT (mean: 113.04 days; range: 5-1362). Of the EIs 78% (52/67) were UTIs and 16% were intra-abdominal infections. The mean duration of antibiotic therapy for EIs was 18.0 ±13 days. Clinical failure occurred in 34% of patients with EIs. There was 1 graft failure, and 6 deaths of which 1 was attributable to Enterococcal bacteremia. Logistic regression analysis revealed that pre-transplant antibiotic use was predictive of adverse outcomes after EI (OR = 5.05, CI = (.94, 27.21), p=.042).
Conclusion: EIs especially UTIs are common after KT, but mortality and graft loss is rare. VRE was isolated in half the EIs, necessitating VRE-specific antibiotic treatment. Clinical failure occurred in about third of patients with EIs and was associated with pre-KT antibiotic exposure.
D. Moreno, None
R. Del Busto, None
M. Ramesh, None
G. Alangaden, None