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Initial empirical antibiotic therapy in kidney transplant recipients with pyelonephritis: A global survey of current practice and opinions across 19 countries on six continents
J. Coussement, SB. Bansal, A. Scemla, MHS. Svensson, LA. Barcan, OC. Smibert, WT. Clemente, F. Lopez-Medrano, T. Hoffman, U. Maggiore, C. Catalano, L. Hilbrands, O. Manuel, T. DU Toit, TKY. Shern, N. Chowdhury, O. Viklicky, R. Oberbauer, S....
Language English Country Denmark
Document type Journal Article
PubMed
39185755
DOI
10.1111/tid.14362
Knihovny.cz E-resources
- MeSH
- Anti-Bacterial Agents * therapeutic use MeSH
- beta-Lactamases MeSH
- Cephalosporins therapeutic use MeSH
- Adult MeSH
- Piperacillin, Tazobactam Drug Combination therapeutic use MeSH
- Practice Patterns, Physicians' statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Transplant Recipients statistics & numerical data MeSH
- Surveys and Questionnaires MeSH
- Pseudomonas aeruginosa drug effects isolation & purification MeSH
- Pyelonephritis * drug therapy microbiology MeSH
- Kidney Transplantation * adverse effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Despite the burden of pyelonephritis after kidney transplantation, there is no consensus on initial empirical antibiotic management. METHODS: We surveyed clinicians throughout the world on their practice and opinions about the initial empirical therapy of post-transplant pyelonephritis, using clinical vignettes. A panel of experts from 19 countries on six continents designed this survey, and invited 2145 clinicians to participate. RESULTS: A total of 721 clinicians completed the survey (response rate: 34%). In the hypothetical case of a kidney transplant recipient admitted with pyelonephritis but not requiring intensive care, most respondents reported initiating either a 3rd-generation cephalosporin (37%) or piperacillin-tazobactam (21%) monotherapy. Several patient-level factors dictated the selection of broader-spectrum antibiotics, including having a recent urine culture showing growth of a resistant organism (85% for extended-spectrum ß-lactamase-producing organisms, 90% for carbapenemase-producing organisms, and 94% for Pseudomonas aeruginosa). Respondents attributed high importance to the appropriateness of empirical therapy, which 87% judged important to prevent mortality. Significant practice and opinion variations were observed between and within countries. CONCLUSION: High-quality studies are needed to guide the empirical management of post-transplant pyelonephritis. In particular, whether prior urine culture results should systematically be reviewed and considered remains to be determined. Studies are also needed to clarify the relationship between the appropriateness of initial empirical therapy and outcomes of post-transplant pyelonephritis.
Department of Infectious Diseases Austin Health Heidelberg Australia
Department of Infectious Diseases Guadeloupe University Hospital Les Abymes France
Department of Kidney Transplant Hospital Evangelico de Minas Gerais Belo Horizonte Brazil
Department of Medicine and Surgery Kidney Pancreas Transplant Unit University of Parma Parma Italy
Department of Medicine Harvard Medical School Boston Massachusetts USA
Department of Nephrology Aalborg University Hospital Aalborg Denmark
Department of Nephrology BRB Hospitals Ltd Dhaka Bangladesh
Department of Nephrology Dialysis and Kidney Transplantation CUB Hôpital Erasme Brussels Belgium
Department of Nephrology Institute for Clinical and Experimental Medicine Prague Czech Republic
Department of Nephrology Medanta Medicity Gurgaon India
Department of Nephrology Radboud University Medical Center Nijmegen The Netherlands
Department of Renal Medicine Singapore General Hospital Singapore Singapore
Division of Nephrology Department of Internal Medicine 3 Medical University of Vienna Vienna Austria
Infectious Diseases Unit Sheba Medical Center Tel Hashomer Israel
Infectious Diseases Unit St Louis Hospital Assistance Publique Hôpitaux de Paris Paris France
Sir Peter MacCallum Department of Oncology University of Melbourne Melbourne Australia
Transplant Unit Groote Schuur Hospital and University of Cape Town Cape Town South Africa
References provided by Crossref.org
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