Antimicrobial resistance in kidney transplant recipients is a growing challenge, especially in the first months after the procedure, when exposure to antibiotics and intense immunosuppression are greatest. This study investigated clinical and microbiological factors associated with early carbapenem resistance. Retrospective cohort study including urine cultures with growth of Gram-negative bacilli in the first 60 days after kidney transplantation, between 2013 and 2023. Resistance to meropenem and its relationship with clinical variables were evaluated. Susceptibility to meropenem was assessed by disk diffusion and interpreted according to BrCAST. Data were stratified into two periods, before and after 2019, to assess the possible impact of the COVID-19 pandemic on bacterial resistance. A total of 1,043 monomicrobial urine cultures were included. The most frequent bacteria were Klebsiella sp. (42.6%), Escherichia coli (28.1%) and Enterobacter sp. (10.7%). Median age was 50 years (38–55), and 53.6% of patients were male. The predominant collection method was midstream urine (97.2%). About 32.8% of urine cultures were performed between 2019 and 2023. The overall meropenem resistance rate was 21%. Male patients (30.2% vs. 11.6%; p < 0.01) and retransplant recipients (51.7% vs. 20.1%; p < 0.001) had higher resistance rates. There were also differences in time to bacteriuria (29 days vs. 24 days; p = 0.003) and in patient age (54 vs. 50 years; p = 0.03) between resistant and susceptible groups, respectively. Resistance increased significantly after 2019 (31.9% vs. 15.7%; p < 0.01). Early carbapenem resistance in kidney transplant recipients was associated with male sex, retransplantation, older age and the post-2019 period, suggesting a possible impact of the pandemic. Monitoring early infections and rational antimicrobial use are essential to mitigate the emergence of resistance in this vulnerable group.
Martini et al. (Sun,) studied this question.