Scholarlink

<p>This study is a post-hoc analysis of a previously published observational study. The aim is to characterize the epidemiology, etiology and antibiotic practices in KTRs admitted due to urosepsis (US) and urinary tract infection (UTI) to a tertiary transplantation center between the period 2014–2019.The two study groups consisted of 101 KTRs with a primary episode of US and 100 randomly selected KTRs hospitalized for UTI as a control group. A post-hoc analysis of clinical and microbiological data was performed, and a local microbiological map was created.The estimated yearly incidence of US in the study population was 21.1 (95% CI: 15.3–26.9) cases per 1000 KTRs per year. Urosepsis accounted for 85% of all sepsis cases. The most common causative pathogen in both groups was <i>Escherichia coli</i>. In 46% and 11% of US and UTI cases, initial empiric antibiotic therapy had to be escalated until day 3 due to lack of clinical response or proven bacterial resistance. This delay in appropriate antibiotic treatment in the US group was significantly associated with mortality (OR = 10.1 with <i>p</i> = 0.021), need for acute renal replacement therapy (OR = 4.73 with <i>p</i> = 0.012) and non-recovery from AKI (OR = 3.18 with <i>p</i> = 0.031). After discharge from hospital, almost 60% of all study subjects received a prophylactic antibiotic course for prevention of UTI recurrence, which did not translate into a lower frequency of readmission due to UTI in a multivariable analysis.US is a common insult that contributes to graft failure in KTRs. We recommend adjusting US and UTI treatments to center-specific microbiological maps in order to optimize treatment outcomes, reduce development of antibiotic resistance, and avoid unnecessary exposure to nephrotoxic antimicrobial drugs.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Antibiotic practices in kidney transplant recipients with urosepsis are associated with treatment outcomes – a post-hoc analysis of an observational study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年6月9日

查看全文
  • Tomasz Królicki,
  • Tobiasz Kudla,
  • Anna Królicka,
  • Klaudia Bardowska,
  • Krzysztof Letachowicz,
  • Ryszard Gawda,
  • Tomasz Czarnik,
  • Magdalena Krajewska,
  • Dorota Kamińska

摘要

This study is a post-hoc analysis of a previously published observational study. The aim is to characterize the epidemiology, etiology and antibiotic practices in KTRs admitted due to urosepsis (US) and urinary tract infection (UTI) to a tertiary transplantation center between the period 2014–2019.The two study groups consisted of 101 KTRs with a primary episode of US and 100 randomly selected KTRs hospitalized for UTI as a control group. A post-hoc analysis of clinical and microbiological data was performed, and a local microbiological map was created.The estimated yearly incidence of US in the study population was 21.1 (95% CI: 15.3–26.9) cases per 1000 KTRs per year. Urosepsis accounted for 85% of all sepsis cases. The most common causative pathogen in both groups was Escherichia coli. In 46% and 11% of US and UTI cases, initial empiric antibiotic therapy had to be escalated until day 3 due to lack of clinical response or proven bacterial resistance. This delay in appropriate antibiotic treatment in the US group was significantly associated with mortality (OR = 10.1 with p = 0.021), need for acute renal replacement therapy (OR = 4.73 with p = 0.012) and non-recovery from AKI (OR = 3.18 with p = 0.031). After discharge from hospital, almost 60% of all study subjects received a prophylactic antibiotic course for prevention of UTI recurrence, which did not translate into a lower frequency of readmission due to UTI in a multivariable analysis.US is a common insult that contributes to graft failure in KTRs. We recommend adjusting US and UTI treatments to center-specific microbiological maps in order to optimize treatment outcomes, reduce development of antibiotic resistance, and avoid unnecessary exposure to nephrotoxic antimicrobial drugs.