Distribution and Antibiotic Susceptibility Pattern of Multidrug-Resistant Bacteria and Risk Factors Among Kidney Transplantation Recipients with Infections Over 13 Years: A Retrospective Study

Figures & data

Table 1 The Clinical Characteristics of Patients with Culture-Proven Infections

Variables	Value
Female	40 (33.6%)
Age	39.5±12.3 (range: 9–66)
Donor type, live	36 (30.3%)
Etiology of kidney disease
Primary glomerulonephritis	113 (95.0%)
Diabetic Nephropathy	5 (4.2%)
Polycystic kidney disease	1 (0.8%)
Comorbidities
Hypertension	89 (74.8%)
Diabetes	12 (10.1%)
Immunosuppression maintenance
FK506 + MM + P	89 (74.8%)
CSA + MM + P	30 (25.2%)
Temperature > 38.5°C	45 (35.4%)
Length of hospitalization	31.5 ± 2.0 (rang: 4–96)
Laboratory findings
Creatinine > 1.5mg/l	59 (46.7%)
Albumin < 30g/l	42 (33.1%)
RDW > 17	41 (32.8%)
Specimens source
Urine	103 (48.1%)
Sputum	65 (30.4%)
Blood	12 (5.6%)
Others	34 (15.9%)

Abbreviations: FK506, tacrolimus; MM, mycophenolate mofetil; P, prednisone; RDW, red blood cell distribution width.

Table 2 Distribution of Micrograms and Changes in the Incidence Rate of MDR Bacteria Types by Year (MDR Number/Total Number)

Microgram	2007–2010	2011–2014	2015–2019	Total	P-value
Gram-negative bacteria	13/38	27/54	33/54	73/146	0.04*
Enterobacteriaceae	10/18	16/22	26/32	52/72	0.015
Non-fermentative	2/19	11/27	6/19	19/65	0.082
Others	1/1	0/5	1/3	2/9	/
Gram-positive bacteria	7/10	15/20	15/17	37/47	/
Enterococcus	4/6	9/13	8/9	21/28	/
Staphylococcus	3/4	6/6	7/8	16/18	/
Others	0/0	1/0	0/0	0/1	/
Fungus†	5	5	11	21	/
Total bacteria	20/48	42/74	48/71	110/193	0.02*

Notes: ^†For fungus, the table only showed the total number. *The P-values are statistically significant.

Abbreviation: MDR, multi-drug resistant;

Figure 1 (A) Time course of infection by the causative pathogens. E. coli: Escherichia coli; P. aeruginosa: Pseudomonas aeruginosa; A. baumannii: Acinetobacter baumannii; K. pneumoniae: Klebsiella pneumoniae; E. faecium: Enterococcus faecium. (B) Time course and frequency of infections post transplantation (m).

Abbreviations: UTI, urinary tract infection; BSI, blood stream infection; SWI, surgical wound infection.

Table 3 Resistance Rate of MDR Gram-Negative Bacteria of KTR (Resistant Number/Test Number/Resistant Rate %)

Antibiotics	Enterobacteriaceae (n = 52)	ESBL- E (n = 38)	Non-Fermentative Bacteria (n = 19)	The Other (n = 2)	Total (n = 73)
Cefazolin	43/48/90.0	36/36/100	10/10/100	1/1/100.0	54/59/91.5
Ceftazidime	32/49/65.3	26/36/76.5	14/17/82.3	1/2/50.0	47/68/69.1
Cefepime	20/46/43.5	17/32/53.1	12/16/75	1/2/50.0	33/64/51.6
Ampicillin	44/44/100	30/30/100	10/10/100	0/1/0	54/55/98.2
Imipenem	2/51/4.0	0/36/0.0	15/18/83.3	1/2/50.0	18/71/25.4
Amikacin	6/46/13.0	5/33/15.2	4/12/33.3	1/1/100.0	11/59/18.6
Gentamicin	32/50/64.0	22/35/62.9	10/17/58.8	0/1/0	42/68/61.8
Ciprofloxacin	26/30/86.7	23/24/95.8	11/13/84.6	1/1/100.0	38/44/86.4
SMZ	46/50/92	34/35/97.1	9/10/90.0	1/2/50.0	56/62/90.3
PIT	10/43/23.3	5/32/15.6	12/16/75	1/2/50.0	23/61/37.7
Aztreonam	26/33/78.8	24/28/85.7	10/10/100.0	/	36/43/83.7

Abbreviations: SMZ, trimethoprim/sulfamethoxazole; PIT, piperacillin/tazobactam; ESBL- E, extended spectrum β-lactamase-producing Enterobacteriaceae.

Table 4 Resistance Rate of Gram-Positive MDR Bacteria for KT Patients (Resistant Number/Test Number/ Resistant Rate [%])

Antibiotics	Enterococcus (n = 21)	Staphylococcus (n = 16)	Total (n = 37)
Ampicillin	20/21/95.2	2/3/66.7	22/24/91.7
Ciprofloxacin	18/19/94.7	5/10/50.0	23/29/79.3
Gentamicin^†	18/19/94.7	9/15/60.0	27/34/79.4
Streptomycin^‡	11/15/73.3	/	11/15/73.3
Linezolid	0/19/0	0/15/0	0/34/0.0
Vancomycin	1/19/5.3	0/15/0	1/34/2.9
Tetracycline	6/11/54.5	3/10/30.0	9/21/42.9
SMZ	/	11/16/68.8	11/16/68.8
Rifampicin	5/5/100	1/14/7.1	6/19/31.6
Erythromycin	10/10/100	12/14/85.7	22/24/91.7
Clindamycin	7/7/100	10/16/62.5	17/23/73.9

Notes: ^†Enterococcus was tested for sensitivity with high level of gentamicin, while Staphylococcus was tested with gentamicin. ^‡Enterococcus was tested for sensitivity with high level of streptomycin, while Staphylococcus was tested with streptomycin.

Abbreviation: SMZ, trimethoprim/sulfamethoxazole.

Table 5 Univariate and Multivariate Analysis of Risk Factors Associated with the Incidence of MDR Infection

Characteristics	MDR (n = 80)	Non-MDR (n = 50)	P -value	OR (95% CI)
Univariate analysis
Female	41	11	0.001*	3.727 (1.675–8.295)
Age > 46 years old	33	12	0.047*	2.223 (1.012–4.884)
Diabetes	7	5	0.811	0.863 (0.258–2.853)
Cadaveric Kidney Donor	59	29	0.087	1.938 (0.909–4.129)
Use of FK506	63	38	0.767	1.140 (0.479–2.412)
Pathogen types > 1	27	8	0.030*	2.675 (1.102–6.492)
Postoperative time <3m	49	28	0.013*	0.363 (0.163–0.808)
Hospitalization stay > 20d	48	27	0.399	1.363 (0.664–2.798)
Infection sites > 1 site	11	4	0.324	1.883 (0.550–6.109)
Temperature > 38.5°C	29	16	0.604	1.221 (0.575–2.593)
Albumin; < 30 g/l	27	15	0.554	1.260 (0.586–2.707)
RDW > 17	21	14	0.730	0.868 (0.390–1.934)
Cr > 1.5mg/dl	34	24	0.671	0.857 (0.419–1.750)
Multivariate analysis
Female			0.006*	3.497 (1.445–8.467)
Pathogen types >1			0.008*	3.832 (1.429–10.273)
Postoperative time <3m			0.014*	0.331 (0.137–0.799)
Age > 46 years old			0.847	1.094 (0.441–2.716)

Note: *The P-values are statistically significant.

Abbreviations: FK506, tacrolimus; RDW, red blood cell distribution width; Cr, creatinine.