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Updated: Apr 3, 2026
Mouse Kidney Transplantation: Models of Allograft Rejection
Published on: October 11, 2014
Multidrug-Resistant Gram-Negative Urinary Tract Infections (UTIs) Increase the Risk of Rejection, CMV Viremia, and
Alessandra Palmisano1, Marta D'Angelo2, Federica Brillo3
1Nephrology Unit, University Hospital of Parma, Parma, Italy.
Background:
Multidrug-resistant (MDR) Gram-negative UTIs caused by extended-spectrum β-lactamases (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE) are increasingly common in kidney transplant recipients (KTR), yet their clinical consequences relative to other Gram-negative infections remain unclear.
Methods:
In this single-center study from a high-endemic area, we retrospectively evaluated the impact of MDR colonization (Colonization), MDR Gram-negative infection (MDR Infection), presumptive MDR infection (i.e., no isolates available; Presump. MDR), and non-MDR Gram-negative infection (non-MDR Inf.) on major post-transplant complications, including CMV and BKPyV viremia, acute rejection, donor-specific antibodies (DSA), graft function, and overall transplant failure. We used multivariable cause-specific hazard Cox regression models with time-varying covariates and random-coefficient mixed models.
Results:
Among 521 KTRs, distributed across overlapping conditions, 212 (40.7%) had MDR Colonization, 92 (17.7%) MDR Infection, 61 (11.7%) Presump. MDR, 67 (12.9%) non-MDR Inf., and 242 (46.4%) had no infection. Compared with No Infection group, only MDR infection was associated with a steeper decline in eGFR slope (-5.50-2.91-0.33 mL/min/1.73 m2 per year; p = 0.027) and increased incidence of transplant failure (adjusted hazard, aHR, associated with history of MDR Infection = 1.76 4.119.61; p = 0.001. MDR infection history was also the only condition associated with CMV viremia (aHR = 1.051.833.18; p = 0.034), and with rejection (aHR = 1.031.692.76; p = 0.036), though it was not associated with BKPyV viremia or de novo DSA. Colonization, Presump. Inf., and non-MDR Inf. were not independently associated with complications or transplant failure.
Conclusion:
Documented MDR Gram-negative UTIs, but not colonization or non-MDR UTI, are independently associated with acute rejection, CMV viremia, and poorer kidney allograft outcomes.
Insights
Multidrug-resistant (MDR) Gram-negative urinary tract infections (UTIs) in kidney transplant recipients are linked to worse outcomes. Documented MDR UTIs, unlike colonization, independently increase risks of rejection and CMV viremia.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Multidrug-resistant (MDR) Gram-negative urinary tract infections (UTIs), including those caused by extended-spectrum β-lactamases (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE), are a growing concern in kidney transplant recipients (KTR).
- The precise clinical impact of these MDR infections compared to other Gram-negative infections on post-transplant complications remains incompletely understood.
Purpose of the Study:
- To retrospectively evaluate the association between MDR colonization, MDR Gram-negative infection, presumptive MDR infection, and non-MDR Gram-negative infection with major post-transplant complications in KTR.
- To determine the independent impact of these conditions on cytomegalovirus (CMV) and BK polyomavirus (BKPyV) viremia, acute rejection, donor-specific antibodies (DSA), graft function, and overall transplant failure.
Main Methods:
- A single-center retrospective study involving 521 kidney transplant recipients from a high-endemic area.
- Multivariable cause-specific hazard Cox regression models with time-varying covariates and random-coefficient mixed models were employed to analyze the data.
- Outcomes assessed included MDR colonization, MDR infection, presumptive MDR infection, non-MDR infection, CMV and BKPyV viremia, acute rejection, DSA development, graft function (eGFR slope), and transplant failure.
Main Results:
- MDR Gram-negative infection was significantly associated with a steeper decline in estimated glomerular filtration rate (eGFR) slope and an increased incidence of transplant failure.
- History of MDR infection was also independently linked to a higher incidence of CMV viremia and acute rejection.
- Colonization, presumptive MDR infection, and non-MDR infection were not found to be independently associated with major post-transplant complications or graft failure.
Conclusions:
- Documented multidrug-resistant Gram-negative UTIs, but not colonization or non-MDR UTIs, are independently associated with adverse clinical outcomes in kidney transplant recipients.
- These findings highlight the significant impact of confirmed MDR Gram-negative infections on acute rejection, CMV viremia, and long-term kidney allograft survival.
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