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. 2024 Feb 15:11:1329778.
doi: 10.3389/fmed.2024.1329778. eCollection 2024.

Frequency and impact on renal transplant outcomes of urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species

Jakob E Brune  1 , Michael Dickenmann  1 , Daniel Sidler  2 , Laura N Walti  3 , Déla Golshayan  4 , Oriol Manuel  4   5 , Fadi Haidar  6 , Dionysios Neofytos  7 , Aurelia Schnyder  8 , Katia Boggian  9 , Thomas F Mueller  10 , Thomas Schachtner  10 , Nina Khanna  11 , Stefan Schaub  1   12 , Caroline Wehmeier  1 ; Swiss Transplant Cohort Study
Collaborators, Affiliations

Frequency and impact on renal transplant outcomes of urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species

Jakob E Brune et al. Front Med (Lausanne). .

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.

Keywords: E. coli; ESBL − extended-spectrum beta-lactamase; Enterobacterales; Klebsiella; graft survival; kidney transplantation; urinary tract infection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Figures

Figure 1
Figure 1
Study flowchart. ESBL, extended-spectrum beta-lactamase; E. coli, Escherichia coli; FU, follow-up; STCS, Swiss Transplant Cohort Study; TRP, transplantation; UTI, urinary tract infection.
Figure 2
Figure 2
Evolution of graft function in patients with Escherichia coli and/or Klebsiella spp. UTI in the first year post-transplant grouped according to ESBL status, shown by violin plots (the lines represent the median (bold) as well as the interquartile ranges). eGFR, estimated glomerular filtration rate; ESBL, extended-spectrum beta-lactamase.
Figure 3
Figure 3
(A) Death-censored graft survival of kidney transplants experiencing first-year UTI events with and without ESBL-producing E. coli and/or Klebsiella spp., shown for colonization and UTI events (left) as well as UTI only (right). (B) Patient survival of kidney transplants experiencing first-year UTI events with and without ESBL-producing E. coli and/or Klebsiella spp., shown for colonization and UTI events (left) as well as UTI only (right). ESBL, extended-spectrum beta-lactamase; E. coli, Escherichia coli; UTI, urinary tract infection.
Figure 4
Figure 4
Distribution of E. coli and/or Klebsiella spp. in (A) all UTI events (n = 825) as well as separately shown in (B) UTI events without (n = 686) and with (n = 139) ESBL-producing strains. ESBL, extended-spectrum beta-lactamase; E. coli, Escherichia coli; UTI, urinary tract infection.
Figure 5
Figure 5
Temporal distribution of UTI events with E. coli/Klebsiella spp. grouped by the presence and absence of an ESBL-producing strain for (A) all UTI events as well as separately shown for (B) colonization and (C) UTI and urosepsis episodes. ESBL, extended-spectrum beta-lactamase; E. coli, Escherichia coli; TMP/SMP, trimethoprim-sulfamethoxazole; UTI, urinary tract infection.
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