Initial empirical antibiotic therapy in kidney transplant recipients with pyelonephritis: A global survey of current practice and opinions across 19 countries on six continents

Coussement, J; Bansal, SB; Scemla, A; Svensson, MHS; Barcan, LA; Smibert, OC; Clemente, WT; Lopez-Medrano, F; Hoffman, T; Maggiore, U; Catalano, C; Hilbrands, L; Manuel, O; Du Toit, T; Shern, TKY; Chowdhury, N; Viklicky, O; Oberbauer, R; Markowicz, S; Kaminski, H; Lafaurie, M; Pierrotti, LC; Cerqueira, TL; Yahav, D; Kamar, N; Kotton, CN

Author(s): Coussement, J; Bansal, SB; Scemla, A; Svensson, MHS; Barcan, LA; Smibert, OC; Clemente, WT; Lopez-Medrano, F; Hoffman, T; Maggiore, U; Catalano, C; Hilbrands, L; Manuel, O; Du Toit, T; Shern, TKY; Chowdhury, N; Viklicky, O; Oberbauer, R; Markowicz, S; Kaminski, H; Lafaurie, M; Pierrotti, LC; Cerqueira, TL; Yahav, D; Kamar, N; Kotton, CN;
Details: Publication Year 2024-12,Volume 26,Issue #6,Page e14362
Journal Title: Transplant Infectious Disease
Publication Type: Research article
Abstract: 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.
Publisher: Wiley
Keywords: Humans; *Pyelonephritis/drug therapy/microbiology; *Kidney Transplantation/adverse effects; *Anti-Bacterial Agents/therapeutic use; Surveys and Questionnaires; Transplant Recipients/statistics & numerical data; Female; Male; Practice Patterns, Physicians'/statistics & numerical data; Piperacillin, Tazobactam Drug Combination/therapeutic use; Adult; Middle Aged; Pseudomonas aeruginosa/drug effects/isolation & purification; Cephalosporins/therapeutic use; beta-Lactamases; antimicrobial stewardship; kidney transplantation; questionnaire; urinary tract infection
Department(s): Infectious Diseases
Publisher's Version: https://doi.org/10.1111/tid.14362
Open Access at Publisher's Site: https://doi.org/10.1111/tid.14362
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-01-14 06:37:59

Last Modified: 2025-01-14 06:38:09