Impact of Gram-Negative Bloodstream Infection on Long-Term Allograft Survival After Kidney Transplantation

Background. Gram-negative bloodstream infections (BSI) are common complications after kidney transplantation. In this cohort study, we evaluated the long-term effect of Gram-negative BSI on allograft survival in kidney transplant recipients. Methods. Among a cohort of 1820 kidney recipients who were prospectively followed at the Mayo Clinic (Rochester, MN) from January 1, 1996, to December 31, 2007, we identified 120 patients with initial episodes of Gram-negative BSI before allograft failure. Multivariable Cox proportional hazard regression was used to examine the association between Gram-negative BSI, as a time-dependent covariate, and allograft and patient survival. Results. The median age of kidney recipients was 51 years (interquartile range, 39-61 years) and 58% were men. Among patients with Gram-negative BSI, 75% had a urinary tract source of infection and Escherichia coli was the most common microorganism (50%). Gram-negative BSI after transplantation was independently associated with allograft loss due to allograft failure or death (hazard ratio [HR], 2.52; 95% confidence intervals [CI], 1.83-3.47; P < 0.001), allograft failure with death-censored (HR, 3.17; 95% CI, 2.11-4.76; P < 0.001) and all-cause mortality (HR, 2.25; 95% CI, 1.55-3.26; P < 0.001). Conclusions. Prevention and proper management of urinary tract infections in kidney recipients is essential to reduce the risk of more serious complications, including Gram-negative BSI, that are associated with reduced allograft and patient survival.