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Volume 49, Number 5, October 2016

Community-onset bacteremia in kidney transplant recipients: The recipients fare well in terms of mortality and kidney injury 


Cong-Tat Cia, Ming-Ji Li, Chia-Wen Li, Nan-Yao Lee, Shen-Shin Chang, Ching-Chi Lee, Wen-Chien Ko


 

Corresponding author:

Corresponding authors. Department of Internal Medicine, National Cheng Kung University Hospital, Number 138, Sheng Li Road, 704, Tainan, Taiwan. 



 

Background and purpose: 

Bloodstream infection is not uncommon in kidney transplant recipients (KTRs) and is associated with mortality, graft loss, and increased medical expenses. Whether these septic patients are more vulnerable to serious complications, resistant strains, or worse clinical outcomes than other patient groups in the community-onset settings remains undetermined. 



 

Methods:

A retrospective study was conducted at a medical center in southern Taiwan. Community-onset bacteremia in the KTRs and a control population at the emergency department were identified. Demographic data, clinical characteristics, bacteremic pathogens, antimicrobial resistance, and clinical outcomes were recorded. 



 

Results:

Forty-one bacteremic episodes in the KTRs and 82 episodes in control patients were studied. The KTR group had younger age, fewer malignancies, more urosepsis (61% vs. 22%, p = 0.004), and fewer biliary tract infections (0% vs. 13.4%, p = 0.018). Escherichia coli was the most commonly isolated pathogen in both the groups (51.2% and 41.5%, respectively). No Klebsiella pneumoniae bacteremia was noted in the KTRs, compared with 14 (17.1%) episodes in the control group (p = 0.010). Antimicrobial resistance profiles of bacteremic pathogens were similar (all p > 0.6). The KTRs with community-onset bacteremia did not have a worse outcome (in-hospital mortality rate: 2.4% vs. 10%, p = 0.172) nor more incomplete resolution of kidney injury after acute kidney injury events (21.1% vs. 25%, p > 0.99) than the control group. 



 

Conclusion:

KTRs with community-onset bacteremia did not fare worse in terms of clinical outcome and kidney injury. 



 

Key words:

bacteremia, kidney injury, kidney transplant recipients