Characterization of Extended-Spectrum β-Lactamase-Producing Uropathogenic Escherichia coli Among Iranian Kidney Transplant Patients

Figures & data

Table 1 Distribution of Characteristics of Kidney Transplant Recipients

Characterization	KTx Recipients* n (%)	Non-KTP n (%)
Sex (female/male)	32/14	45/20
Age (Mean, Median, Range)	50.8; 53; (15–82)	45:42; (1–80)
Hypertension	50% (19/38)	-
Diabetes mellitus	28.9% (11/38)	7.7% (5/65)
Immunosuppression	100 (46/46)	0 (0/65)
Time from last KTx to UTI (Range)	4 month- 21 year	-
Ureteral stent or urinary catheter	0 (0/38)	0(0/65)
Hospitalization	0 (0/46)	0 (0/65)
Recurrent UTI	42.1% (16/38)	-
History of UTI	57.9% (22/38)	-
Antibiotic therapy	31.6% (12/38)	0(0/65)
Clinical data of a three-month period before the UTI diagnosis
Hospitalization	7.9% (3/38)	(0/65)
Surgery	(0/38)	-
Ureteral stent or urinary catheter	(0/38)	-
Antibiotic therapy	39.5% (15/38)	0 (0/65)

Note: *Eight KTP information was missed.

Table 2 Antibiotic Susceptibility Pattern of UPEC Isolates Among KTP and Control Group

Antimicrobial category	Antibiotics	KTP					p-value	Control-group					p-value	p-value KTP vs control-group
		Total resistance	ESBL-positive isolates (20)		ESBL-negative isolates (26)			Total resistance	ESBL-positive isolates (15)		ESBL-negative isolates (50)
			R	S	R	S			R	S	R	S
Beta-lactams	Amoxicillin/clavulanic	15 (32.6)	7 (35)	10 (50)	8 (30.8)	18 (69.2)	0.098	15 (23.1)	7 (46.7)	7 (46.7)	8 (16)	40 (80)	0.079	0.53
	Piperacillin-tazobactam	6 (13)	6 (30)	14 (70)	0	26 (100)	0.004	7 (10.8)	3 (20)	12 (80)	4 (8)	45 (90)	0.37	0.6
	Cefoxitin	10 (21.7)	7 (35)	13 (65)	3 (11.5)	23 (88.5)	0.06	15 (23.1)	6 (40)	9 (60)	9 (18)	41 (82)	0.08	0.86
	Ceftazidim	23 (50)	20 (100)	0	3 (11.5)	23 (88.5)	≤ 0.001	22 (33.8)	15 (100)	0	7 (14)	43 (86)	≤ 0.001	0.08
	Cefepime	10 (21.7)	9 (45)	6 (30)	1 (3.8)	23 (88.5)	≤ 0.001	7 (10.8)	2 (13.3)	12 (80)	5 (10)	45 (90)	0.16	0.004
	Cefixim	27 (58.7)	15 (75)	5 (25)	12 (46.2)	14 (53.8)	0.04	22 (33.8)	13 (86.7)	2 (13.3)	9 (18)	49 (80)	≤ 0.001	0.02
Carbapenem	Imipenem	0	0	26 (100)	0	20 (100)	-	0	0	15 (100)	0	50 (100)	-	0.2
	Meropenem	0	0	26 (100)	0	20 (100)	-	0	0	15 (100)	0	50 (100)	-	0.2
Sulfonamides	Trimethoprim/ sulfamethoxazole	39 (84.8)	17 (85)	3 (15)	22 (84.6)	4 (15.4)	0.9	30 (46.2)	9 (60)	6 (40)	21 (42)	28 (56)	0.43	≤ 0.001
Quinolones	Ciprofloxacin	25 (54.3)	16 (80)	4 (20)	9 (34.6)	16 (61.5)	0.008	24 (36.9)	10 (66.7)	5 (33.3)	14 (28)	35 (70)	0.024	0.17
	Ofloxacin	24 (52.2)	16 (80)	4 (20)	8 (30.8)	18 (69.2)	≤ 0.001	31 (47.7)	12 (80)	3 (20)	19 (38)	30 (60)	0.017	0.6
	Nalidixic acid acid	36 (78.3)	18 (90)	2 (10)	18 (69.2)	8 (30.8)	0.15	38 (58.5)	12 (80)	2 (13.3)	26 (52)	21 (42)	0.12	0.047
	Norfloxacin	26 (56.5)	16 (80)	4 (20)	10 (38.5)	16 (61.5)	0.005	23 (35.4)	10 (66.7)	5 (33.3)	13 (26)	37 (74)	0.004	0.027
Nitrofurans	Nitrofurantoin	11 (23.9)	3 (15)	15 (75)	8 (30.8)	18 (69.2)	0.14	6 (9.2)	0	14 (93.3)	6 (12)	44 (88)	0.075	0.06
Aminoglycosides	Gentamicin	15(32.6)	10 (50)	10 (50)	5 (19.2)	21 (80.8)	0.27	11 (16.9)	6 (40)	9 (60)	5 (10)	45 (90)	0.014	0.055
	Amikacin	0	0	26 (100)	0	20 (100)	-	0	0	15 (100)	0	48 (100)	0.43	0.2

Table 3 Antibiotic Susceptibility Pattern Among ESBLs and Non-ESBL Isolates Among KTP and Control Group

Antimicrobial Category	Antibiotics	ESBL-Positive Isolates				p-value	ESBL-Negative Isolates				p-value
		KTP		Control Group			KTP		Control-Group
		R	S	R	S		R	S	R	S
Beta-lactams	Amoxicillin/clavulanic	7 (35)	10 (50)	7 (46.7)	7 (46.7)	0.6	8 (30.8)	18 (69.2)	8 (16)	40 (80)	0.32
	Piperacillin-tazobactam	6 (30)	14 (70)	3 (20)	12 (80)	0.39	0	26 (100)	4 (8)	45 (90)	0.25
	Cefoxitin	7 (35)	13 (65)	6 (40)	9 (60)	0.76	3 (11.5)	23 (88.5)	9 (18)	41 (82)	0.35
	Ceftazidim	20 (100)	0	15 (100)	0	-	3 (11.5)	23 (885)	7 (14)	43 (86)	0.53
	Cefixim	15 (75)	5 (25)	13 (86.7)	2 (13.3)	0.39	12 (46.2)	14 (53.8)	9 (18)	40 (80)	0.02
	Cefepime	9 (45)	6 (30)	2 (13.3)	12 (80)	0.14	1 (3.8)	23 (88.5)	5 (10)	45 (90)	0.09
Carbapenem	Imipenem	0	20 (100)	0	15 (100)	-	0	26 (100)	0	26 (100)	0.2
	Meropenem	0	20 (100)	0	15 (100)	-	0	26 (100)	0	26 (100)	0.2
Sulfonamides	Trimethoprim/sulfamethoxazole	17 (85)	3 (15)	9 (60)	6 (40)	0.1	22 (84.6)	4 (15.4)	21 (42)	28 (56)	0.002
Quinolones	Ciprofloxacin	16 (80)	4 (20)	10 (66.7)	5 (33.3)	0.3	9 (34.6)	16 (61.5)	14 (28)	35 (70)	0.7
	Ofloxacin	16 (80)	4 (20)	12 (80)	3 (20)	1.00	8 (30.8)	18 (69.2)	19 (38)	30 (60)	0.6
	Nalidixic acid	18 (90)	2 (10)	12 (80)	2 (13.3)	0.46	18 (69.2)	8 (30.8)	26 (52)	21 (42)	0.22
	Norfloxacin	16 (80)	4(40)	10 (66.7)	5 (33.3)	0.3	10 (38.5)	16 (61.5)	13 (26)	37 (74)	0.26
Nitrofurans	Nitrofurantoin	3 (15)	15 (75)	0	14 (93.3)	0.25	8 (30.8)	18 (69.2)	6 (12)	44 (88)	0.063
Aminoglycosides	Gentamicin	10 (50)	10 (50)	6 (40)	9 (60)	0.5	5 (19.2)	21 (80.8)	5 (10)	45 (90)	0.29
	Amikacin	0	20 (100)	0	15 (100)	-	0	26 (100)	2 (4)	48 (96)	0.3

Table 4 Distribution of ESBL Genes Among ESBLs and Non-ESBL Isolates

ESBL Genes	Total 111	ESBL-Positive Isolates			p-value	ESBL- Negative Isolates			p-value	p-value
		Total 35	KTP 20	Control Group 15		Total 76	KTP 26	Control-Group 50
CTX-M	59 (53.2)	29 (82.9)	19 (95)	10 (66.7)	0.02	30 (39.5)	14 (53.8)	16 (32)	0.06	≤0.001
TEM	50 (45)	14 (40)	11 (55)	3 (20)	0.03	36 (47.4)	15 (57.7)	21 (42)	0.19	0.46
SHV	6 (5.4)	1 (2.9)	1 (5)	0	0.3	5 (6.6)	2 (7.7)	3 (6)	0.7	0.42
CTX-M+ TEM	29 (26.1)	13 (37.1)	11 (55)	2 (13.3)	0.01	16 (21.05)	9 (34.6)	7 (14)	0.03	-
CTX-M+ SHV	4 (3.6)	1 (2.9)	1 (5)	0	-	3 (3.9)	1 (3.8)	2 (4)	-	0.7
TEM+ SHV	3 (2.7)	1 (2.9)	1 (5)	0	-	2 (2.6)	1 (3.8)	1 (2)	-	0.9
CTX-M+TEM+SHV	3 (2.7)	1 (2.9)	1 (5)	0	-	5 (6.6)	2 (7.7)	3 (6)	-	0.4