Urinary tract infections among kidney transplant patients due to extended-spectrum beta-lactamase-producing bacteria

CORRE
At present, in patients with end stage of renal failure, kidney trans
lantation is a selective therapeutic strategy due to better rates of life
articipation [1,2]. However, receiving of immunosuppressant med
cation encounter kidney transplant patients (KTPs) at increased risk
f cancer, infection, diabetes and cardiovascular disease [3]. The pres
nce of infections greatly influences the success of kidney transplan
ation since they cause higher morbidity and mortality and also in
rease the length and expenditure of hospitalization [4]. Of the in
ections, urinary tract infection (UTI) has been considered a common
roblem, occurring in 60% of KTPs during the first year post-trans
lant [5]. Some studies reported an increased incidence of bacter
al infection with multiple antibiotic resistances among transplant pa
ients [6]. Of the bacteria, extended spectrum beta-lactamases (ES
BLs) producing gram negative bacteria most commonly Escherichia
oli and Klebsiella spp have the ability to hydrolyze and cause resis
ance to oxyiminocephalosporins and monobactams [7,8]. Recently,
he prevalence of CTX-M-type ESBLs (bla CTX-M) has been increased
nd such ESBLs may cause resistance to some unrelated classes of an
ibiotics [9]. CTX-M enzymes are currently divided into five clusters
n the basis of amino acid sequence, including: CTX-M-1, CTX-M-2,
CTX-M-8, CTX-M-9 and CTX-M-25 [10]. Since the infections can
ffect renal transplantation outcomes and little information were avail
ble regarding the frequency of ESBLs among KTPs, this study was
esigned to investigate the susceptibility pattern, frequency of ESBLs
nd bla CTX-M among the isolated E. coli and Klebsiella spp from urine
pecimens of KTPs using phenotypic and molecular methods.