Surveillance of nosocomial infections in kidney and liver transplant recipients in Rasht, Northern Iran

Solid organ transplant (SOT) recipients are at heightened risk of hospital-acquired infections (HAIs) due to immunosuppressive therapy and frequent exposure to invasive procedures. HAIs, particularly those caused by multidrug-resistant (MDR) organisms, remain a major source of morbidity, prolonged hospitalization, and mortality in this population. Despite the global significance of this issue, regional data on post-transplant HAIs and antimicrobial resistance in Northern Iran remain limited. This study aimed to investigate the prevalence, microbial etiology, and antibiotic resistance patterns of HAIs among kidney and liver transplant recipients at a tertiary referral hospital in Rasht, Iran. A retrospective cross-sectional study was conducted at Razi Hospital from March, 2018, to February, 2023. Clinical, microbiological, and demographic data were collected for transplant recipients diagnosed with HAIs ≥48 hours after hospital admission. Among 141 transplant recipients, 14 (9.9%) developed confirmed HAIs. urinary tract infections were the most prevalent (57.1%), followed by bloodstream infections (21.4%), ventilator-associated pneumonia (14.3%), and surgical site infections (7.1%). The most frequently isolated organism was Escherichia coli (42.9%), followed by Staphylococcus spp., Acinetobacter spp., Citrobacter spp., and Klebsiella spp. (each 14.3%). Antimicrobial susceptibility testing revealed diverse resistance patterns among the isolated organisms; however, the rates of drug resistance among Gram-negative bacteria was high. This study highlights a moderate prevalence of nosocomial infections among transplant recipients in Northern Iran, with Gram-negative MDR pathogens posing significant therapeutic challenges. These findings emphasize the need for enhanced infection control policies, continuous microbiological surveillance, and locally informed antimicrobial stewardship programs to improve outcomes in transplant populations.