Infecciones bacterianas en pacientes receptores de trasplante renal y reno-páncreas: Alta incidencia de microorganismos multirresistentes

Julio César Medina; Virginia Antelo; Marcelo Nin; Zaida Arteta; Francisco González; Cristina Bazet; Rossana Astesiano; Rossana Cordero; Daniel López; Sergio Orihuela

Authors

Julio César Medina Universidad de la República, Facultad de Medicina, Cátedra de Enfermedades Infecciosas. Profesor Agregado
Virginia Antelo Universidad de la República, Facultad de Medicina, Cátedra de Enfermedades Infecciosas. Ex Residente, Especialista en Enfermedades Infecciosas
Marcelo Nin Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Nefrología, Trasplante. Profesor Agregado
Zaida Arteta Universidad de la República, Facultad de Medicina, Cátedra de Enfermedades Infecciosas, Parasitología. Profesor Adjunto
Francisco González Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Nefrología. Profesor
Cristina Bazet Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Departamento Laboratorio Clínico, Repartición Microbiología. Ex Profesora Agregada
Rossana Astesiano Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Nefrología. Asistente
Rossana Cordero Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Cátedra de Nefrología. Ex Asistente
Daniel López Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Área de Trasplantes. Coordinador quirúrgico y Profesor Agregado
Sergio Orihuela Universidad de la República, Facultad de Medicina, Hospital de Clínicas, Programa de Trasplante Renal. Ex Director. Cátedra de Nefrología. Ex Profesor Agregado

Keywords:

KIDNEY TRANSPLANTATION, PANCREAS TRANSPLANTATION, BACTERIAL INFECTIONS

Abstract

Introduction: bacterial infections in kidney (KTX) and kidney-pancreas transplant (KPTX) recipients are frequent and constitute one of the leading causes of death in this group of patients. The profile of these microorganisms needs to be identified in order to improve the empirical therapeutic approach.
Objective: to learn about the etiology and characteristics of both community and hospital-acquired bacterial infections in a group of patients who received KTX and KPTX, and were see at the Clinicas Hospital from November 1987 through November, 2010.
Method: retrospective study of the evolution of all patients with KTX and KPTX who were admitted at the Clinicas Hospital and presented at least one bacterial etiology infection episode, community and hospital-acquired. A multidrug-resistant (MDR) microorganism was defined if it were resistant to MRSA, VRE or a gram negative bacilli resistant to at least three groups of antimicrobial agents.
Results: during the period of study 122 patients received KTX or KPTX (six patients were transplanted in a center different form the Clinicas Hospital). Out of these patients, 64 (52.5%) developed at least one bacterial infection episode; 34 of them were women (53.1%), average age was 37.7± 11.4 years old. Thirty nine patients received KTX (60.1%) and 25 (39.1%) KPTX. Median follow up was five months (P25 = 1, P75 = 25). There were 138 bacterial infection episodes (2.07 episodes/patient), 76 of which were community acquired and 62 were hospital acquired. In both cases, the most frequent center of infection was the urinary system (63.2% and 53.2% respectively), followed respiratory infections in the community acquired infections (13%). E. coli was the predominant microorganism, followed by Klebsiella spp. and Enterococcus spp. Out of 103 microorganisms isolated, 46 (44.7%) evidenced multidrug-resistance - Klebsiella spp. and Acinetobacter baumannii being the most frequent agents).
Conclusions: the most frequent center of infection in community acquired infections were urinary and respiratory infections. As to hospital acquired infections, surgical lesions infections and urinary infections prevailed. E. coli and Klebsiella spp were the most frequent microorganisms in the community and Enterococcus spp., Klebsiella spp. and Acinetobacter baumannii were the most frequent one in the hospital context. A high prevalence of MO-MR was found in the first six months after transplantation, where A. baumannii appears as a problem pathogen given its high drug resistance.

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