Mark Melzer1, Territa Santhakumaran2, Catherine Welch3. 1. Royal London Hospital, Barts Health NHS Trust, 3rd floor Pathology and Pharmacy Building, 80 Newark St., London, E1 2ES, UK. mark.melzer@bartshealth.nhs.uk. 2. SpR in Renal Medicine, Ward 9F, 9th floor, Royal London Hospital, Whitechapel Rd., Whitechapel, London, E1 1BB, UK. 3. Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
Abstract
BACKGROUND: There is lack of outcome data for bacteraemic patients on specialist renal units. We described demographic, clinical, microbiological data and outcomes for bacteraemic adult renal transplant and non-transplant patients at a London Teaching Hospital. We also assessed the appropriateness of empirical antibiotic policy. METHODS: From December 2012 to November 2013, demographic, clinical and microbiological data were collected on consecutive patients with bacteraemia on a specialist UK renal unit. Empirical anti-microbial policy, based upon sites of infection, was piperacillin/tazobactam and amikacin, or meropenem for graft pyelonephritis, and vancomycin and gentamicin for suspected central venous catheter (CVC) associated infection. RESULTS: 113 bacteraemic episodes occurred in 83 patients. One patient had two bacteraemic episodes, one on haemodialysis and another after transplantation so appear in both groups. In the non-transplant group, 30-day mortality was 4/59 (6.8 %), more than the renal transplant group, 0/25 (0 %). While graft pyelonephritis was the predominant cause of bacteraemic episodes in renal transplant patients, 25/36 (69.4 %), there were a variety of other causes in the non-transplant group including uncomplicated line associated bacteraemia, 36/77 (46.8 %), complicated line associated bacteraemia, 11/77 (14.3 %) and bacteraemia unrelated to vascular access sites 19/77 (24.7 %). Overall, commonest isolates were Methicillin-sensitive Staphylococcus aureus 20/77 (26.3 %), and Escherichia coli 28/113 (24.8 %). There were no Methicillin-resistant Staphylococcus aureus isolates and, among Enterobacteriaceae, 15/57 (26.3 %) were extended spectrum beta-lactamase producers. CONCLUSIONS: Death only occurred in the non-transplant renal group. Empirical antibiotic treatment with either piperacillin/tazobactam and amikacin, or meropenem was appropriate for renal transplant recipients as most bacteraemic episodes were secondary to graft pyelonephritis. Vancomycin and gentamicin was appropriate empirical antibiotic treatment for non-transplant patients with CVC associated infections, but not optimal for other sites of infection.
BACKGROUND: There is lack of outcome data for bacteraemic patients on specialist renal units. We described demographic, clinical, microbiological data and outcomes for bacteraemic adult renal transplant and non-transplant patients at a London Teaching Hospital. We also assessed the appropriateness of empirical antibiotic policy. METHODS: From December 2012 to November 2013, demographic, clinical and microbiological data were collected on consecutive patients with bacteraemia on a specialist UK renal unit. Empirical anti-microbial policy, based upon sites of infection, was piperacillin/tazobactam and amikacin, or meropenem for graft pyelonephritis, and vancomycin and gentamicin for suspected central venous catheter (CVC) associated infection. RESULTS: 113 bacteraemic episodes occurred in 83 patients. One patient had two bacteraemic episodes, one on haemodialysis and another after transplantation so appear in both groups. In the non-transplant group, 30-day mortality was 4/59 (6.8 %), more than the renal transplant group, 0/25 (0 %). While graft pyelonephritis was the predominant cause of bacteraemic episodes in renal transplant patients, 25/36 (69.4 %), there were a variety of other causes in the non-transplant group including uncomplicated line associated bacteraemia, 36/77 (46.8 %), complicated line associated bacteraemia, 11/77 (14.3 %) and bacteraemia unrelated to vascular access sites 19/77 (24.7 %). Overall, commonest isolates were Methicillin-sensitive Staphylococcus aureus 20/77 (26.3 %), and Escherichia coli 28/113 (24.8 %). There were no Methicillin-resistant Staphylococcus aureus isolates and, among Enterobacteriaceae, 15/57 (26.3 %) were extended spectrum beta-lactamase producers. CONCLUSIONS: Death only occurred in the non-transplant renal group. Empirical antibiotic treatment with either piperacillin/tazobactam and amikacin, or meropenem was appropriate for renal transplant recipients as most bacteraemic episodes were secondary to graft pyelonephritis. Vancomycin and gentamicin was appropriate empirical antibiotic treatment for non-transplant patients with CVC associated infections, but not optimal for other sites of infection.
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