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Title: | Initial empirical antibiotic therapy in kidney transplant recipients with pyelonephritis: A global survey of current practice and opinions across 19 countries on six continents. | Austin Authors: | Coussement, Julien;Bansal, Shyam B;Scemla, Anne;Svensson, My H S;Barcan, Laura A;Smibert, Olivia C ;Clemente, Wanessa T;Lopez-Medrano, Francisco;Hoffman, Tomer;Maggiore, Umberto;Catalano, Concetta;Hilbrands, Luuk;Manuel, Oriol;DU Toit, Tinus;Shern, Terence Kee Yi;Chowdhury, Nizamuddin;Viklicky, Ondrej;Oberbauer, Rainer;Markowicz, Samuel;Kaminski, Hannah;Lafaurie, Matthieu;Pierrotti, Ligia C;Cerqueira, Tiago L;Yahav, Dafna;Kamar, Nassim;Kotton, Camille N | Affiliation: | Department of Infectious Diseases, Guadeloupe University Hospital, Les Abymes, France.;Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia. Department of Nephrology, Medanta-Medicity, Gurgaon, India. Department of Kidney Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique - Hôpitaux de Paris, Paris, France. Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark. Internal Medicine Department, Infectious Diseases Section, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. Infectious Diseases Department of Laboratory Medicine, Transplant Program, Hospital das Clínicas-Universidade Federal de Minas Gerais (UFMG), School of Medicine (UFMG), Belo Horizonte, Brazil. Department of Medicine, Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), School of Medicine, Universidad Complutense, Madrid, Spain. Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel. Department of Medicine and Surgery, Kidney-Pancreas Transplant Unit, University of Parma, Parma, Italy. Department of Nephrology, Dialysis and Kidney Transplantation, CUB-Hôpital Erasme, Brussels, Belgium. Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands. Transplantation Centre and Service of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland. Transplant Unit, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore. Department of Nephrology, BRB Hospitals Ltd, Dhaka, Bangladesh. Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. Division of Nephrology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria. Department of Infectious Diseases, Guadeloupe University Hospital, Les Abymes, France. Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux, France. Infectious Diseases Unit, St-Louis Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, Sao Paulo, Brazil. Department of Kidney Transplant, Hospital Evangelico de Minas Gerais, Belo Horizonte, Brazil. Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel. Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse Institute for Infectious and Inflammatory Diseases (Infinity), University Paul Sabatier, Toulouse, France. Transplant Infectious Disease and Compromised Host Program, Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.;Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA. |
Issue Date: | 26-Aug-2024 | Date: | 2024 | Publication information: | Transplant Infectious Disease: an Official Journal of the Transplantation Society 2024-08-26 | Abstract: | Despite the burden of pyelonephritis after kidney transplantation, there is no consensus on initial empirical antibiotic management. 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. 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. 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. | URI: | https://ahro.austin.org.au/austinjspui/handle/1/35475 | DOI: | 10.1111/tid.14362 | ORCID: | 0000-0002-4302-6599 0000-0001-5333-7529 0000-0003-3535-6835 0000-0001-7607-0943 0000-0001-5250-855X 0000-0002-0043-7216 0000-0001-7544-6275 0000-0003-1604-3825 0000-0003-3181-9791 0000-0003-1930-8964 0000-0001-7320-2234 |
Journal: | Transplant Infectious Disease : an Official Journal of the Transplantation Society | Start page: | e14362 | PubMed URL: | 39185755 | ISSN: | 1399-3062 | Type: | Journal Article | Subjects: | antimicrobial stewardship kidney transplantation questionnaire urinary tract infection |
Appears in Collections: | Journal articles |
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