Please use this identifier to cite or link to this item: http://hdl.handle.net/2381/43653
Title: The characteristics and outcome of bacteraemia in renal transplant recipients and non-transplant renal patients
Authors: Melzer, M
Santhakumaran, T
Welch, C
First Published: 2-May-2016
Publisher: Springer Verlag for Urban and Vogel
Citation: Infection, 2016, 44 (5), pp. 617-622
Abstract: BACKGROUND: There is lack of outcome data for bacteraemic patients on specialist renal units. We described demographic, clinical, microbiological data and outcomes for bacteraemic adult renal transplant and non-transplant patients at a London Teaching Hospital. We also assessed the appropriateness of empirical antibiotic policy. METHODS: From December 2012 to November 2013, demographic, clinical and microbiological data were collected on consecutive patients with bacteraemia on a specialist UK renal unit. Empirical anti-microbial policy, based upon sites of infection, was piperacillin/tazobactam and amikacin, or meropenem for graft pyelonephritis, and vancomycin and gentamicin for suspected central venous catheter (CVC) associated infection. RESULTS: 113 bacteraemic episodes occurred in 83 patients. One patient had two bacteraemic episodes, one on haemodialysis and another after transplantation so appear in both groups. In the non-transplant group, 30-day mortality was 4/59 (6.8 %), more than the renal transplant group, 0/25 (0 %). While graft pyelonephritis was the predominant cause of bacteraemic episodes in renal transplant patients, 25/36 (69.4 %), there were a variety of other causes in the non-transplant group including uncomplicated line associated bacteraemia, 36/77 (46.8 %), complicated line associated bacteraemia, 11/77 (14.3 %) and bacteraemia unrelated to vascular access sites 19/77 (24.7 %). Overall, commonest isolates were Methicillin-sensitive Staphylococcus aureus 20/77 (26.3 %), and Escherichia coli 28/113 (24.8 %). There were no Methicillin-resistant Staphylococcus aureus isolates and, among Enterobacteriaceae, 15/57 (26.3 %) were extended spectrum beta-lactamase producers. CONCLUSIONS: Death only occurred in the non-transplant renal group. Empirical antibiotic treatment with either piperacillin/tazobactam and amikacin, or meropenem was appropriate for renal transplant recipients as most bacteraemic episodes were secondary to graft pyelonephritis. Vancomycin and gentamicin was appropriate empirical antibiotic treatment for non-transplant patients with CVC associated infections, but not optimal for other sites of infection.
DOI Link: 10.1007/s15010-016-0896-9
eISSN: 1439-0973
Links: https://link.springer.com/article/10.1007%2Fs15010-016-0896-9
http://hdl.handle.net/2381/43653
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © Springer-Verlag Berlin Heidelberg 2016. Deposited with reference to the publisher’s open access archiving policy. (http://www.rioxx.net/licenses/all-rights-reserved)
Appears in Collections:Published Articles, Dept. of Cardiovascular Sciences

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