Toward an optimization of empirical antibiotic therapy in acute graft pyelonephritis: A retrospective multicenter study.

Autor: Martinet P; Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France. Electronic address: pauline.martinet@ch-cornouaille.fr., Lanfranco L; Nephrology and Transplantation Unit, La Cavale Blanche University Hospital. Brest, France., Coste A; Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France., Tandé D; Department of Bacteriology, La Cavale Blanche University Hospital. Brest, France., Danneels P; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France; Infectious Diseases and Tropical Medicine, Angers University Hospital, Angers, France., Picard L; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France; Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France., Danthu C; Nephrology, Limoges University Hospital, Limoges, France., Jamard S; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France; Infectious Diseases and Tropical Medicine, Tours University Hospital, Tours, France., Gaborit B; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France; Infectious Diseases and Tropical Medicine, Nantes University Hospital, Nantes, France., Faucher JF; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France; Infectious Diseases and Tropical Medicine, Limoges University Hospital, Limoges, France., Talarmin JP; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France; Infectious Diseases and Tropical Medicine, Cornouaille Hospital, Quimper, France., Le Meur Y; Nephrology and Transplantation Unit, La Cavale Blanche University Hospital. Brest, France., An Nguyen T; Urology, La Cavale Blanche University Hospital, Brest, France., Masset C; Institut de Transplantation-Urologie-Néphrologie (ITUN), INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes University Hospital, Nantes, France., Kerleau C; Institut de Transplantation-Urologie-Néphrologie (ITUN), INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes University Hospital, Nantes, France., Ansart S; Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France., Rezig S; Infectious Diseases and Tropical Medicine, La Cavale Blanche University Hospital, Brest, France; Groupe d'Epidémiologie et Recherche en Infectiologie Clinique du Centre et de l'Ouest (GERICCO), France.
Jazyk: angličtina
Zdroj: Infectious diseases now [Infect Dis Now] 2024 Aug; Vol. 54 (5), pp. 104922. Date of Electronic Publication: 2024 May 14.
DOI: 10.1016/j.idnow.2024.104922
Abstrakt: Objective: Acute graft pyelonephritis (AGPN) is the most frequent infectious complication in kidney transplant recipients (KTR). The treatment of acute community-acquired (CA) pyelonephritis is based on third-generation cephalosporins (3GC) and fluoroquinolones. Cefepime or a piperacillin-tazobactam combination are more often used in healthcare-associated (HCA) infections. However, these recommendations do not consider the resistance observed in KTRs. The objective of our study was to define the most appropriate empirical antibiotherapy for AGPN in KTRs according to the CA and HCA settings. To answer this question, we assessed the prevalence of resistance to different antibiotics usually recommended for urinary tract infections (UTIs) in the general population.
Methods: Observational, retrospective, multicenter study covering all episodes of AGPN occurring in hospitalized KTRs in 2019.
Results: A total of 210 patients were included in 7 centers and 244 episodes of AGPN were analyzed (158 CA-AGPN and 86 HCA-AGPN). The prevalence of 3GC and fluoroquinolone resistance was 23 % (n = 36) and 30 % (n = 50) in CA infections (n = 158), and 47 % (n = 40) and 31 % (n = 27) in HCA infections (n = 86), respectively. Cefepime resistance rate was 19 % (n = 30) in CA-AGPN and 29 % (n = 25) in HCA-AGPN. Piperacillin-tazobactam combination had resistance rates > 15 % in both CA and HCA infections. The only antimicrobials with resistance rates < 10 % were aminoglycosides and carbapenems.
Conclusion: None of the antibiotics recommended in empirical treatment in UTIs has shown a resistance rate of less than 10% with regard to AGPN. Therefore, none of them should be used as monotherapy. A combination therapy including amikacin could be an appropriate strategy in this setting.
(Copyright © 2024 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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