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 10⁵ 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 for Klebsiella pneumoniae (258 samples, 33.0%), Escherichia coli (212, 27.0%), Enterococcus faecalis (128, 24.0%), and Enterococcus faecium (125, 16.0%). The decrease in susceptibility of E. coli to 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% in E. faecium. Susceptibility to tigecycline remained 100% through all years in case of E. faecalis and E. 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) in K. pneumoniae and against gentamicin in E. faecalis (p = 0.015). Higher resistance to ampicillin in E. 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) in K. pneumoniae was 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 in K. 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.

中文翻译：

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超过8年的肾脏移植受者尿路感染导致肺炎克雷伯菌，大肠杆菌，粪肠球菌和粪肠球菌对某些抗生素敏感性的分析：单中心研究。

背景：尿路感染（UTI）是肾移植（KTX）接受者中最常见的细菌感染。这项研究的目的是分析负责KTX受体的UTI的四种最常见病原体的抗药性（AMR），并确定同一组中抗药性的危险因素（RF）。方法：分析的抗菌素谱是根据2011-2018年入院时出现UTI症状的住院成人KTX接受者获得的10 ^5个菌落形成单位（CFU）/ mL细菌生长呈阳性的尿液样本得出的。结果：总共分析了783份肺炎克雷伯菌的抗菌谱图（258份样品，占33.0％），埃希菌大肠杆菌（212，27.0％），粪肠球菌（128，24.0％） 和粪肠球菌（125，16.0％）。观察到大肠杆菌对阿莫西林/克拉维酸（62.9％比40.0％）和环丙沙星（100％到40.0％）的敏感性降低。粪肠球菌对庆大霉素的敏感性从33.3％增加到92.9％。敏感性替加环素在所有多年的情况下，仍保持100％的粪肠球菌和屎肠球菌。男性对阿莫西林/克拉维酸（p = 0.008），环丙沙星（p = 0.0003），甲氧苄氨嘧啶/磺胺甲恶唑（p 肺炎克雷伯菌中的头孢曲松钠（p = 0.00009），头孢曲松（p = 0.0001）和头孢呋辛酯（p = 0.00038），而在粪肠球菌中对庆大霉素（p = 0.015）。在氨苄青霉素较高电阻粪肠球菌（p = 0.012）和环丙沙星（p = 0.0003），甲氧苄啶/磺胺甲恶唑（p = 0.007），哌拉西林/三唑巴坦（p = 0.003），头孢曲松（p = 0.001），和头孢呋辛酯在较高年龄组的患者中观察到肺炎克雷伯菌（p = 0.013）。糖尿病是肾功能不全的原因（p= 0.026），RF肾-胰腺移植（p = 0.014）对肺炎克雷伯菌对头孢曲松的耐药性。结论：来自KTX接受者的尿路致病菌中的AMR波动。在所检查的细菌-抗生素组合中，有明确的耐药性RF。我们建议对特定地点的微生物进行连续定位，因为病因和敏感性在不同机构之间可能会随时间而变化。