The long-term impact of bloodstream infections on patient and graft survival following kidney transplantation

Background: There are limited data on the impact of bloodstream infections (BSI) following kidney transplantation (KT) on long term patient outcome. Methods: This was a retrospective parallel-cohort study. We included 123 consecutive KT recipients who were admitted with a first episode of BSI between January 2007 and December, 2016. They were matched with 225 KT recipients who did not have BSI. Multivariate regression analysis with BSI as time-dependent covariate was used for the effect of BSI on graft loss, all-cause mortality and long-term graft function (defined by the slope of mean serum creatinine level). Results: During a median follow-up of 89.4 months, post-transplant BSI was independently associated with all-cause mortality (HR 5.56, 95% CI 3.07–10.09, P <.0001) and graft failure (HR-2.82, 95% CI 1.40–5.64, P =.003) after adjustment for potential confounders. This association remained irrespective of the source of infection or pathogen, but became nonsignificant when appropriate antibiotic therapy was administrated. Baseline kidney function was independently associated with graft failure. Recipients with BSI had lower baseline kidney function; however, the BSI episode had no influence on the slope of change in serum creatinine over time. Conclusion: BSI after KT was associated with long-term adverse outcome. This effect was mitigated by the early administration of appropriate antibiotics.