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

2024-12

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

antimicrobial stewardship

kidney transplantation

questionnaire

urinary tract infection

Journal Article

0000-0002-4302-6599

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0000-0003-3535-6835

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0000-0001-7607-0943

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0000-0001-5250-855X

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0000-0002-0043-7216

0000-0001-7544-6275

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0000-0003-1604-3825

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0000-0003-3181-9791

0000-0003-1930-8964

0000-0001-7320-2234

10.1111/tid.14362

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.

link

Transplant Infectious Disease: an Official Journal of the Transplantation Society 2024-12; 26(6)

Transplant Infectious Disease : an Official Journal of the Transplantation Society

1399-3062