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

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.

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

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

(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

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

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.