Antibiotic Selective Pressure and Development of Bacterial Resistance Detected in Bacteriuria Following Kidney Transplantation

Abstract Introduction Bacteriuria (symptomatic and asymptomatic) is the most common infectious complication after kidney transplantation. This study aimed to determine its prevalence among kidney transplant recipients hospitalized after transplantation, respective risk factors, and frequency of isolates and antibacterial susceptibility. Methods Retrospectively, we divided hospitalized patients into 3 groups. Groups 1 and 2 included 78 and 152 recipients with and without bacteriuria, respectively, and the potential risk factors were compared. Cefixime was prescribed as early postsurgical prophylaxis. Group 3 patients were 116 randomly selected nontransplantation patients with urinary tract infection. Frequency of uropathogens and their antibiotic susceptibility were compared in groups 1 and 3. Results In total, 103 bacteriuria episodes were detected in 15.2% of the patients. The frequency of risk factors in groups 1 and 2 was similar. Escherichia coli was the most common isolate in groups 1 (40.8%) and 3 (68.1%; P = .03). Streptococcus faecalis was the most common gram-positive isolate in groups 1 (17.5%) and 3 (6.9%; P = .03). Sensitivity rates in group 1 were 9% to trimethoprim-sulfamethoxazole, 20% to ciprofloxacin, and 38.4% to gentamicin, which was not significantly different from group 3. However, the sensitivity rates of gram-negative isolates to ceftriaxone were 9.5% and 28.4% ( P = .004) in groups 1 and 3, respectively, and to cefixime 4.5% and 22% ( P = .01). Discussion High antibacterial resistance of uropathogens isolated from kidney transplantation and nontransplantation patients is alarming. The higher resistance to third-generation cephalosporins in transplant recipients may be due to antibiotic selection pressure secondary to postsurgical prophylaxis with cefixime.