Early Onset Bacteremia in Kidney Transplant Recipients in the Current Era

Bloodstream infection (BSI) after kidney transplantation increases the risk of graft loss and mortality. We aimed to identify contemporary risk factors and outcomes of early BSI (eBSI) at our transplant center.

We conducted a retrospective chart review of adult kidney transplant recipients (KTRs) from 2019 to 2023. Those with the eBSI (within 90 days of KTR) were matched by age and gender to controls. Risk factors were identified using multivariable logistic regression. All KTRs surviving to 90 days, were included in graft and patient survival analysis.

Among 1408 KTRs, 75 (5.3%) developed eBSI, at a median of 21 days (IQR: 12-42.5). On multivariable analysis, each doubling of hospital duration was independently associated with a 49% increase in the risk of eBSI (OR: 1.49, 95% CI: 1.19-1.91; p < 0.001), and each doubling of postsurgical drain retention duration was independently associated with a 68% increase in the risk of eBSI (OR: 1.68, 95% CI: 1.17-2.48; p 0.006). eBSI was associated with 1-year mortality (aHR: 3.32, 95% CI: 1.51-7.28; p 0.003) and 3-year graft failure (aHR: 2.78, 95% CI: 1.31-5.93; p 0.008).

eBSI was associated with graft failure and mortality. The donor and recipient factors identified highlight the need for further studies to better characterize their impact on eBSI.