222. Bloodstream Infections by Gram(−) Bacteria in Kidney Transplant Patients: Risk Factors, Incidence and Outcome; Bloodstream Infections by Gram(−) Bacteria in Kidney Transplant Patients: Risk Factors, Incidence and Outcome

BACKGROUND: Kidney transplant recipients are at increased risk for infections. The aims of this study were: i) to estimate the incidence of bloodstream infections (BSI) caused by Gram(−) bacteria in kidney transplant recipients, ii) to identify risk factors for BSI by multidrug-resistant Gram(−) bacteria, and iii) to identify predictors for outcome (death/loss of transplanted kidney). METHODS: We conducted a retrospective cohort study at the renal transplant unit (RTU) of a tertiary care hospital located in Athens, Greece, between September 2008 and September 2018. Kidney transplant recipients with Gram(−) BSIs were identified from the microbiology laboratory electronic records. Patient-, infection-, and treatment-related factors were extracted from the medical records. Species identification and susceptibility testing were performed by MicroScan automated system. The statistical analysis was performed using IBM SPSS Statistics v20. RESULTS: During the study period, 1962 kidney transplant patients were followed at our RTU. A total of 195 BSI episodes were recorded in 182 patients (male/female=97/85), with median (25th, 75th) age 57.2 (44, 64.9) years. The incidence of BSI was 1.393/100 patient-years. Median (25(th), 75(th)) time interval between transplantation date and onset of BSI was 67.67 (8.3, 148) months. Escherichia coli was the most common cause (64.3%, 117/182), while the most common source of infection was urinary tract (70.9%, 129/182). 19.2% (53/182) of BSIs were caused by multidrug-resistant organisms (MDR). 6% (11/182) of patients died and 2.2% (4/182) were subjected to nephrectomy. Multivariate logistic regression showed that diabetes mellitus (odds ratio [OR] 7.714; 95% confidence interval [CI] 1.311–45.385), Pseudomonas aeruginosa BSI (OR 35.788; CI 3.3–388.182) and septic shock (OR 74.468; CI 3.513–1578.513) were predictors of an unfavorable outcome. Previous antibiotic use (OR 11.964; CI 2.686–53.293) and previous stay in Intensive Care Unit (OR 18.055; CI 1.046–311.536) were associated with MDR BSIs. CONCLUSION: BSIs in kidney transplant recipients is a critical factor of morbidity and mortality. Recognizing the risk factors for unfavorable outcome and emergence of MDR bacteria could offer a significant advantage in early diagnosis and appropriate treatment. DISCLOSURES: All authors: No reported disclosures.