{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T03:59:40Z","timestamp":1786420780383,"version":"build-2736575974"},"reference-count":43,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T00:00:00Z","timestamp":1775088000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transplant Infectious Dis"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multidrug\u2010resistant (MDR) Gram\u2010negative UTIs caused by extended\u2010spectrum \u03b2\u2010lactamases (ESBL) and carbapenem\u2010resistant Enterobacteriaceae (CRE) are increasingly common in kidney transplant recipients (KTR), yet their clinical consequences relative to other Gram\u2010negative infections remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In this single\u2010center study from a high\u2010endemic area, we retrospectively evaluated the impact of MDR colonization (\n                      <jats:italic>Colonization<\/jats:italic>\n                      ), MDR Gram\u2010negative infection (\n                      <jats:italic>MDR Infection<\/jats:italic>\n                      ), presumptive MDR infection (i.e., no isolates available;\n                      <jats:italic>Presump. MDR<\/jats:italic>\n                      ), and non\u2010MDR Gram\u2010negative infection (\n                      <jats:italic>non\u2010MDR Inf<\/jats:italic>\n                      .) on major post\u2010transplant complications, including CMV and BKPyV viremia, acute rejection, donor\u2010specific antibodies (DSA), graft function, and overall transplant failure. We used multivariable cause\u2010specific hazard Cox regression models with time\u2010varying covariates and random\u2010coefficient mixed models.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 521 KTRs, distributed across overlapping conditions, 212 (40.7%) had\n                      <jats:italic>MDR Colonization<\/jats:italic>\n                      , 92 (17.7%)\n                      <jats:italic>MDR Infection<\/jats:italic>\n                      , 61 (11.7%)\n                      <jats:italic>Presump. MDR<\/jats:italic>\n                      , 67 (12.9%)\n                      <jats:italic>non\u2010MDR Inf<\/jats:italic>\n                      ., and 242 (46.4%) had no infection. Compared with No Infection group, only MDR infection was associated with a steeper decline in eGFR slope (\n                      <jats:sub>\u22125.50<\/jats:sub>\n                      \u22122.91\n                      <jats:sub>\u22120.33<\/jats:sub>\n                      \u00a0mL\/min\/1.73\u00a0m\n                      <jats:sup>2<\/jats:sup>\n                      per year;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.027) and increased incidence of transplant failure (adjusted hazard, aHR, associated with history of\n                      <jats:italic>MDR Infection\u00a0<\/jats:italic>\n                      =\u00a0\n                      <jats:sub>1.76<\/jats:sub>\n                      4.11\n                      <jats:sub>9.61<\/jats:sub>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001. MDR infection history was also the only condition associated with CMV viremia (aHR\u00a0=\u00a0\n                      <jats:sub>1.05<\/jats:sub>\n                      1.83\n                      <jats:sub>3.18<\/jats:sub>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.034), and with rejection (aHR\u00a0=\u00a0\n                      <jats:sub>1.03<\/jats:sub>\n                      1.69\n                      <jats:sub>2.76<\/jats:sub>\n                      ;\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.036), though it was not associated with BKPyV viremia or de novo DSA.\n                      <jats:italic>Colonization<\/jats:italic>\n                      ,\n                      <jats:italic>Presump. Inf<\/jats:italic>\n                      ., and\n                      <jats:italic>non\u2010MDR Inf<\/jats:italic>\n                      . were not independently associated with complications or transplant failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Documented MDR Gram\u2010negative UTIs, but not colonization or non\u2010MDR UTI, are independently associated with acute rejection, CMV viremia, and poorer kidney allograft outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/tid.70212","type":"journal-article","created":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T10:13:16Z","timestamp":1775124796000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Multidrug\u2010Resistant Gram\u2010Negative Urinary Tract Infections (UTIs) Increase the Risk of Rejection, CMV Viremia, and Graft Loss After Kidney Transplantation"],"prefix":"10.1111","volume":"28","author":[{"given":"Alessandra","family":"Palmisano","sequence":"first","affiliation":[{"name":"Nephrology Unit University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"D'Angelo","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Brillo","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Hepatology Unit University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Salvetti","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Parmigiani","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessio Di","family":"Maria","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Saracino","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Salsi","sequence":"additional","affiliation":[{"name":"Infectious Diseases and Hepatology Unit University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela","family":"Gentile","sequence":"additional","affiliation":[{"name":"Nephrology Unit University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe Daniele","family":"Benigno","sequence":"additional","affiliation":[{"name":"Nephrology Unit University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Gandolfini","sequence":"additional","affiliation":[{"name":"Nephrology Unit University Hospital of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Fiaccadori","sequence":"additional","affiliation":[{"name":"Nephrology Unit University Hospital of Parma  Parma Italy"},{"name":"Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Cravedi","sequence":"additional","affiliation":[{"name":"Translational Transplant Research Center Department of Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Umberto","family":"Maggiore","sequence":"additional","affiliation":[{"name":"Nephrology Unit University Hospital of Parma  Parma Italy"},{"name":"Department of Medicine and Surgery University of Parma  Parma Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,2]]},"reference":[{"key":"e_1_2_5_2_1","unstructured":"E. 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