4CPS-039 Nosocomial infection by multiresistant pathogens in kidney transplant patients

Background and importanceImmunosuppression related to organ transplant is a risk factor for multidrug resistant infections.Aim and objectivesTo evaluate the prevalence of nosocomial infections (NI) by multidrug resistant (MDR) pathogens, aetiologic agents and treatments given to a cohort of patients undergoing kidney transplantation (KT).Material and methodsA retrospective observational study was carried out in a cohort of patients having undergone a KT during 2016–2017. Variables collected: demographics, clinical (type of KT and aetiologic agent) and therapeutic (induction immunosuppressant treatments and empirical and targeted antimicrobials) data.ResultsSixty-four patients who had undergone a KT (84.4% from a cadaver, 7.8% from a live donor and 7.8% kidney–pancreas) were included (mean age 53.6±15.3 years, 72.9% men).The most frequent induction immunosuppressant treatments were: basiliximab+mycophenolate–mofetil+steroid+tacrolimus (31.2%) and thymoglobulin+mycophenolate-mofetil+steroid+tacrolimus (65.6%).Eight of 64 patients developed NI by MDR pathogens during hospitalisation as a result of the KT (prevalence 12.5%), isolating a total of 10 multiresistant causative agents: Escherichia coli (30%), Pseudomonas aeruginosa and Klebsiella pneumoniae (extended spectrum beta lactamase producing, oxa-48 carbapenemase producing (20% each) and carbapenemase producing (10%)).The sources of NI were: urinary tract (50%), central venous catheter (30%) and abdominal (20%).Based on patient symptoms, empirical administered antibiotics were: ceftazidime (30%), ciprofloxacin (20%), ceftriaxone (20%), meropenem, levofloxacin (10%) and piperacillin–tazobactam (10%). In all cases, once the aetiologic agent was isolated, targeted treatment was used.It is worth noting the use of ceftazidime–avibactam in two cases of infection with MDR carbapenemase oxa-48 producing K pneumoniae. None of the patients died due to the NI. Of the patients treated with the immunosuppressant regimen that included basiliximab, 40% developed NI by MDR pathogens in contrast with the group that received the regimen including thymoglobulin (2.5%). This difference was significant (p=0.0875).Conclusion and relevanceIn our cohort of patients there was a high prevalence of NI by MDR pathogens, with K pneumoniae the most frequent. Ceftazidime was the most commonly used antibiotic as an empirical treatment, and urinary infections the most prevalent within our population. There seems to be a correlation betwee