Incidences of Infectious Events in a Renal Transplant Cohort of the German Center of Infectious Diseases (DZIF)

Claudia Sommerer; Iris Schröter; Katrin Gruneberg; Daniela Schindler; Rouven Behnisch; Christian Morath; Lutz Renders; Uwe Heemann; Paul Schnitzler; Anette Melk; Andrea Della Penna; Silvio Nadalin; Klaus Heeg; Stefan Meuer; Martin Zeier; Thomas Giese; Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium

doi:10.1093/ofid/ofac243

Incidences of Infectious Events in a Renal Transplant Cohort of the German Center of Infectious Diseases (DZIF)

Open Forum Infect Dis. 2022 May 13;9(7):ofac243. doi: 10.1093/ofid/ofac243. eCollection 2022 Jul.

Authors

Claudia Sommerer¹, Iris Schröter¹, Katrin Gruneberg¹, Daniela Schindler², Rouven Behnisch³, Christian Morath¹, Lutz Renders², Uwe Heemann², Paul Schnitzler², Anette Melk², Andrea Della Penna⁴, Silvio Nadalin², Klaus Heeg², Stefan Meuer², Martin Zeier¹, Thomas Giese²; Transplant Cohort of the German Center for Infection Research (DZIF Transplant Cohort) Consortium

Affiliations

¹ Nephrology, University Hospital Heidelberg, Heidelberg, Germany.
² German Centre for Infection Research (DZIF), Germany.
³ Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany.
⁴ Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany.

Abstract

Background: Infectious complications are a major cause of morbidity and mortality after kidney transplantation.

Methods: In this transplant cohort study at the German Center of Infectious Diseases (DZIF), we evaluated all infections occurring during the first year after renal transplantation. We assessed microbial etiology, incidence rates, and temporal occurrence of these infections.

Results: Of 804 renal transplant recipients (65.2% male, 51 ± 14 years), 439 (54.6%) had 972 infections within the first year after transplantation. Almost half of these infections (47.8%) occurred within the first 3 months. Bacteria were responsible for 66.4% (645/972) of all infections, followed by viral (28.9% [281/972]) and fungal (4.7% [46/972]) pathogens. The urinary tract was the most common site of infection (42.4%). Enterococcus was the most frequently isolated bacterium (20.9%), followed by E. coli (17.6%) and Klebsiella (12.5%). E. coli was the leading pathogen in recipients <50 years of age, whereas Enterococcus predominated in older recipients. Resistant bacteria were responsible for at least 1 infection in 9.5% (76/804) of all recipients. Viral infections occurred in 201 recipients (25.0%). Of these, herpes viruses predominated (140/281 [49.8%]), and cytomegalovirus had the highest incidence rate (12.3%). In the 46 fungal infections, Candida albicans (40.8%) was the most commonly isolated. Other fungal opportunistic pathogens, including Aspergillus fumigatus and Pneumocystis, were rare.

Conclusions: Renal allograft recipients in Germany experience a high burden of infectious complications in the first year after transplantation. Bacteria were the predominating pathogen, followed by opportunistic infections such as cytomegalovirus. Microbial etiology varied between age groups, and resistant bacteria were identified in 10% of recipients.

Keywords: DZIF; German; cohort study; infection; renal transplantation.