{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T22:15:09Z","timestamp":1775168109195,"version":"3.50.1"},"reference-count":29,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Despite the burden of pyelonephritis after kidney transplantation, there is no consensus on initial empirical antibiotic management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We surveyed clinicians throughout the world on their practice and opinions about the initial empirical therapy of post\u2010transplant pyelonephritis, using clinical vignettes. A panel of experts from 19 countries on six continents designed this survey, and invited 2145 clinicians to participate.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 721 clinicians completed the survey (response rate: 34%). In the hypothetical case of a kidney transplant recipient admitted with pyelonephritis but not requiring intensive care, most respondents reported initiating either a 3rd\u2010generation cephalosporin (37%) or piperacillin\u2010tazobactam (21%) monotherapy. Several patient\u2010level factors dictated the selection of broader\u2010spectrum antibiotics, including having a recent urine culture showing growth of a resistant organism (85% for extended\u2010spectrum \u00df\u2010lactamase\u2010producing organisms, 90% for carbapenemase\u2010producing organisms, and 94% for <jats:italic>Pseudomonas aeruginosa<\/jats:italic>). Respondents attributed high importance to the appropriateness of empirical therapy, which 87% judged important to prevent mortality. Significant practice and opinion variations were observed between and within countries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>High\u2010quality studies are needed to guide the empirical management of post\u2010transplant pyelonephritis. In particular, whether prior urine culture results should systematically be reviewed and considered remains to be determined. Studies are also needed to clarify the relationship between the appropriateness of initial empirical therapy and outcomes of post\u2010transplant pyelonephritis.\n<jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tid14362-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1111\/tid.14362","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T11:33:45Z","timestamp":1724672025000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Initial empirical antibiotic therapy in kidney transplant recipients with pyelonephritis: A global survey of current practice and opinions across 19 countries on six continents"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4302-6599","authenticated-orcid":false,"given":"Julien","family":"Coussement","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Guadeloupe University Hospital  Les Abymes France"},{"name":"Sir Peter MacCallum Department of Oncology University of Melbourne  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shyam B.","family":"Bansal","sequence":"additional","affiliation":[{"name":"Department of Nephrology Medanta\u2010Medicity  Gurgaon India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Scemla","sequence":"additional","affiliation":[{"name":"Department of Kidney Transplantation H\u00f4pital Necker\u2010Enfants Malades, Assistance Publique \u2013 H\u00f4pitaux de Paris  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"My H. S.","family":"Svensson","sequence":"additional","affiliation":[{"name":"Department of Nephrology Aalborg University Hospital  Aalborg Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura A.","family":"Barcan","sequence":"additional","affiliation":[{"name":"Internal Medicine Department Infectious Diseases Section Hospital Italiano de Buenos Aires  Buenos Aires Argentina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olivia C.","family":"Smibert","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Austin Health  Heidelberg Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wanessa T.","family":"Clemente","sequence":"additional","affiliation":[{"name":"Department of Laboratory Medicine Transplant Program Hospital das Cl\u00ednicas\u2010Universidade Federal de Minas Gerais (UFMG) School of Medicine (UFMG)  Belo Horizonte Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5333-7529","authenticated-orcid":false,"given":"Francisco","family":"Lopez\u2010Medrano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Unit of Infectious Diseases, Hospital Universitario \u201c12 de Octubre\u201d, Instituto de Investigaci\u00f3n Sanitaria Hospital \u201c12 de Octubre\u201d (imas12), Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), School of Medicine Universidad Complutense  Madrid Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3535-6835","authenticated-orcid":false,"given":"Tomer","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, Sheba Medical Center  Tel Hashomer Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Umberto","family":"Maggiore","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery Kidney\u2010Pancreas Transplant Unit University of Parma  Parma Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Concetta","family":"Catalano","sequence":"additional","affiliation":[{"name":"Department of Nephrology Dialysis and Kidney Transplantation, CUB\u2010H\u00f4pital Erasme  Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luuk","family":"Hilbrands","sequence":"additional","affiliation":[{"name":"Department of Nephrology Radboud University Medical Center  Nijmegen The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7607-0943","authenticated-orcid":false,"given":"Oriol","family":"Manuel","sequence":"additional","affiliation":[{"name":"Transplantation Centre and Service of Infectious Diseases University Hospital of Lausanne  Lausanne Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tinus","family":"DU TOIT","sequence":"additional","affiliation":[{"name":"Transplant Unit Groote Schuur Hospital and University of Cape Town  Cape Town South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5250-855X","authenticated-orcid":false,"given":"Terence Kee Yi","family":"Shern","sequence":"additional","affiliation":[{"name":"Department of Renal Medicine Singapore General Hospital  Singapore Singapore"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nizamuddin","family":"Chowdhury","sequence":"additional","affiliation":[{"name":"Department of Nephrology BRB Hospitals Ltd  Dhaka Bangladesh"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0043-7216","authenticated-orcid":false,"given":"Ondrej","family":"Viklicky","sequence":"additional","affiliation":[{"name":"Department of Nephrology Institute for Clinical and Experimental Medicine  Prague Czech Republic"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7544-6275","authenticated-orcid":false,"given":"Rainer","family":"Oberbauer","sequence":"additional","affiliation":[{"name":"Division of Nephrology Department of Internal Medicine III Medical University of Vienna  Vienna Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Markowicz","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Guadeloupe University Hospital  Les Abymes 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France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7320-2234","authenticated-orcid":false,"given":"Camille N.","family":"Kotton","sequence":"additional","affiliation":[{"name":"Transplant Infectious Disease and Compromised Host Program Division of Infectious Diseases Massachusetts General Hospital  Boston Massachusetts USA"},{"name":"Department of Medicine Harvard Medical School  Boston Massachusetts 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