Analysis of Susceptibility to Selected Antibiotics inKlebsiella pneumoniae, Escherichia coli, Enterococcus faecalisandEnterococcus faeciumCausing Urinary Tract Infections in Kidney Transplant Recipients over 8 Years: Single-Center Study

Background:Urinary tract infections (UTIs) are the most common bacterial infections among kidney transplant (KTX) recipients. The purpose of this study was to analyze antimicrobial resistance (AMR) in four most common pathogens responsible for UTIs in KTX recipients and determine risk factors (RF) for resistance in the same group.Methods:Analyzed antibiograms were based on urine samples positive for bacterial growth of 10(5)colony-forming units (CFU)/mL obtained from hospitalized adult KTX recipients presenting with UTI symptoms upon admission to the center in years 2011-2018.Results:In total, 783 antibiograms were analyzed forKlebsiella pneumoniae(258 samples, 33.0%),Escherichia coli(212, 27.0%),Enterococcus faecalis(128, 24.0%), andEnterococcus faecium(125, 16.0%). The decrease in susceptibility ofE. colito amoxicillin/clavulanic acid (62.9% vs. 40.0%) and ciprofloxacin (100% to 40.0%) was observed. Susceptibility to gentamicin increased from 33.3% to 92.9% inE. faecium. Susceptibility to tigecycline remained 100% through all years in case ofE. faecalisandE. faecium. Male gender was a RF for resistance to amoxicillin/clavulanic acid (p= 0.008), ciprofloxacin (p= 0.0003), trimethoprim/sulfamethoxazole (p= 0.00009), ceftriaxone (p= 0.0001), and cefuroxime axetil (p= 0.00038) inK. pneumoniaeand against gentamicin inE. faecalis(p= 0.015). Higher resistance to ampicillin inE. faecalis(p= 0.012) and to ciprofloxacin (p= 0.0003), trimethoprim/sulfamethoxazole (p= 0.007), piperacillin/tazobactam (p= 0.003), ceftriaxone (p= 0.001), and cefuroxime axetil (p= 0.013) inK. pneumoniaewas observed in higher age groups of patients. Diabetes as a cause of kidney insufficiency (p= 0.026) and kidney-pancreas transplantation (p= 0.014) was RF for resistance to ceftriaxone inK. pneumoniae.Conclusions:AMR in uropathogens from KTX recipients fluctuated. There were identifiable RFs for resistance in the examined bacteria-antibiotic combinations. We recommend continuous mapping of site-specific microorganisms as etiology and susceptibility may vary between institutions and over time.