2306. Impact of a Surgical Antimicrobial Prophylaxis Change on the Epidemiology of Urine Isolates in Kidney Transplant Recipients
Session: Poster Abstract Session: Transplants: Infection Epidemiology and Outcome in Solid Organ Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Posters
  • 2306_IDWposter.pdf (911.3 kB)
  • Background:

    Bacteriuria with gram-negative bacilli and enterococci following kidney transplantation (KT) is common and has been linked to poor outcomes, including graft rejection. In 2012, our KT surgical antimicrobial prophylaxis protocol was changed from cefazolin to ampicillin-sulbactam in an attempt to decrease enterococcal urinary tract infections.

    Methods:

    Urine isolates (ISO) for 1 year after transplant for 1165 KTs from 2007-2011 and 587 KTs from 2013-2015 were reviewed. KTs during 2012 were excluded as a protocol transition period. The first ISO of each organism per KT recipient was included. ISO were stratified by time post-KT. We aimed to compare rates of bacteriuria and organisms isolated as well as graft survival before and after the protocol switch.

    Results:

    KT recipients were 62% male with a median age of 51 years (range 18-84) and were similar between the two time periods. There were 555 ISO from 377 patients from 2007-2011 and 300 ISO from 196 patients from 2013-2015. There was an increase in the rate of bacteriuria within 7 days (6% vs. 10%, p=0.003) and within 30 days (18% vs. 22%, p=0.03) post-KT. E. coli, E. faecalis, K. pneumoniae, and E. faecium remained the most common ISO both within 30 days and 12 months of KT during both periods. The rate of E. coli within 7 days of KT increased (24% vs. 42%, p=0.03) after the switch, overtaking E. faecalis (35% vs. 29%, p=0.58) as the most common ISO in the first week post-KT. ISO antibiotic susceptibility rates were not significantly different between the periods with the exception of improved gram-negative susceptibility to levofloxacin (66% vs. 78%, p=0.005) and increased resistance in E. coli to piperacillin-tazobactam (95% vs. 80%, p=0.001). There was no difference in overall 12-month graft survival (94% vs. 93%, p=0.92) between the two time periods. Graft survival at 12-months (94% vs. 90%, p=0.007) was decreased among all KTs with bacteriuria within 30 days.

    Conclusion:

    E. coli remained the most common ISO in the first year post-KT, and also surpassed E. faecalis in the first week post-KT. A change in surgical prophylaxis from cefazolin to ampicillin-sulbactam resulted in an increased incidence of bacteriuria in the early post-KT period that may have an impact on early graft outcomes.

    Justin G. Aaron, MD1, Christine J. Kubin, PharmD BCPS (AQ-ID)2, Demetra Tsapepas, PharmD3, Mariana C. Chiles, MPH4, Geoffrey Dube, MD5, Sumit Mohan, MD, MPH5 and Marcus R. Pereira, MD, MPH2, (1)Division of Infectious Diseases, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, (2)Division of Infectious Diseases, Columbia University Medical Center, New York, NY, (3)Department of Surgery, New York Presbyterian - Columbia University Medical Center, New York, NY, (4)Division of Nephrology, Columbia University Medical Center, New York, NY, (5)Division of Nephrology, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY

    Disclosures:

    J. G. Aaron, None

    C. J. Kubin, None

    D. Tsapepas, None

    M. C. Chiles, None

    G. Dube, None

    S. Mohan, None

    M. R. Pereira, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.