Toward an optimization of empirical antibiotic therapy in acute graft pyelonephritis: A retrospective multicenter study - 18/07/24
, Luca Lanfranco c, Anne Coste a, b, Didier Tandé d, Pierre Danneels b, e, Léa Picard b, f, Clément Danthu g, Simon Jamard b, h, Benjamin Gaborit b, i, Jean-François Faucher b, j, Jean-Philippe Talarmin b, k, Yannick Le Meur c, Truong An Nguyen l, Christophe Masset m, 1, Clarisse Kerleau m, 1, Séverine Ansart a, b, Schéhérazade Rezig a, bon behalf of the EPAGGO study group
Highlights |
• | A high rate of resistance among Enterobacterales responsible for acute graft pyelonephritis (AGPN) in western France (and probably the entire country). |
• | None of the antibiotics recommended in empirical treatment in urinary tract infections have shown a resistance rate of less than 10% in AGPN. |
• | Need to revise guidelines for empirical treatment of AGPN in the light of local epidemiology. |
• | A combination therapy including amikacin could be an appropriate strategy in this setting. |
Abstract |
Objective |
Acute graft pyelonephritis (AGPN) is the most frequent infectious complication in kidney transplant recipients (KTR). The treatment of acute community-acquired (CA) pyelonephritis is based on third-generation cephalosporins (3GC) and fluoroquinolones. Cefepime or a piperacillin-tazobactam combination are more often used in healthcare-associated (HCA) infections. However, these recommendations do not consider the resistance observed in KTRs. The objective of our study was to define the most appropriate empirical antibiotherapy for AGPN in KTRs according to the CA and HCA settings. To answer this question, we assessed the prevalence of resistance to different antibiotics usually recommended for urinary tract infections (UTIs) in the general population.
Methods |
Observational, retrospective, multicenter study covering all episodes of AGPN occurring in hospitalized KTRs in 2019.
Results |
A total of 210 patients were included in 7 centers and 244 episodes of AGPN were analyzed (158 CA-AGPN and 86 HCA-AGPN). The prevalence of 3GC and fluoroquinolone resistance was 23 % (n = 36) and 30 % (n = 50) in CA infections (n = 158), and 47 % (n = 40) and 31 % (n = 27) in HCA infections (n = 86), respectively. Cefepime resistance rate was 19 % (n = 30) in CA-AGPN and 29 % (n = 25) in HCA-AGPN. Piperacillin-tazobactam combination had resistance rates > 15 % in both CA and HCA infections. The only antimicrobials with resistance rates < 10 % were aminoglycosides and carbapenems.
Conclusion |
None of the antibiotics recommended in empirical treatment in UTIs has shown a resistance rate of less than 10% with regard to AGPN. Therefore, none of them should be used as monotherapy. A combination therapy including amikacin could be an appropriate strategy in this setting.
Le texte complet de cet article est disponible en PDF.Keywords : Kidney transplantation, Acute graft pyelonephritis, Microbial epidemiology, Antibiotic resistance, Urinary tract infection
Abbreviations : 3GC, 4GC, AGPN, APTP, CA, ESBL, ESCMID, HCA, ICU, IDSA, KDIGO, KTR, SPILF, UTIs
Plan
Vol 54 - N° 5
Article 104922- août 2024 Retour au numéro
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