Antibiotic practices in kidney transplant recipients with urosepsis are associated with treatment outcomes - a post-hoc analysis of an observational study.

This study is a post-hoc analysis of a previously published observational study. The aim is to characterize the epidemiology, etiology and antibiotic practices in KTRs admitted due to urosepsis (US) and urinary tract infection (UTI) to a tertiary transplantation center between the period 2014-2019.The two study groups consisted of 101 KTRs with a primary episode of US and 100 randomly selected KTRs hospitalized for UTI as a control group. A post-hoc analysis of clinical and microbiological data was performed, and a local microbiological map was created.The estimated yearly incidence of US in the study population was 21.1 (95% CI: 15.3-26.9) cases per 1000 KTRs per year. Urosepsis accounted for 85% of all sepsis cases. The most common causative pathogen in both groups was Escherichia coli. In 46% and 11% of US and UTI cases, initial empiric antibiotic therapy had to be escalated until day 3 due to lack of clinical response or proven bacterial resistance. This delay in appropriate antibiotic treatment in the US group was significantly associated with mortality (OR = 10.1 with p = 0.021), need for acute renal replacement therapy (OR = 4.73 with p = 0.012) and non-recovery from AKI (OR = 3.18 with p = 0.031). After discharge from hospital, almost 60% of all study subjects received a prophylactic antibiotic course for prevention of UTI recurrence, which did not translate into a lower frequency of readmission due to UTI in a multivariable analysis.US is a common insult that contributes to graft failure in KTRs. We recommend adjusting US and UTI treatments to center-specific microbiological maps in order to optimize treatment outcomes, reduce development of antibiotic resistance, and avoid unnecessary exposure to nephrotoxic antimicrobial drugs.