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Hosseinpour M, Pezeshgi A, Mahdiabadi MZ, Sabzghabaei F, Hajishah H, Mahdavynia S. Prevalence and risk factors of urinary tract infection in kidney recipients: a meta-analysis study. BMC Nephrol 2023; 24:284. [PMID: 37759155 PMCID: PMC10523791 DOI: 10.1186/s12882-023-03338-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND A kidney recipient's urinary tract infection (UTI) can result in infectious problems and be a risk factor for less successful transplant outcomes. UTI risk factors are still controversial. The present study aimed to investigate the prevalence of UTI and its association with risk factors in kidney recipients. METHOD Twenty-six papers published between 2005 and 2022 were retrieved using keywords and searching Medlib, ScienceDirect, PubMed, and other databases. If possible, the pooled prevalence of UTI in kidney recipients and odds ratio (OR) with a 95% confidence interval for each risk factor were calculated. The data were analyzed using the random effects model in R and Stata 14. RESULTS The total sample size was 72,600, with an average age of 48.7 years. The pooled prevalence of UTI was 35% (95% CI, 30-40%). The estimated risk factors for UTI were female (OR = 3.13; 95%CI: 2.35-4.17), older age (OR = 1.03; 95%CI: 1-1.05), history of UTI (OR = 1.31; 95%CI) CI: 1.05-1.63), receiving a kidney from a deceased donor (OR = 1.59; 95%CI: 1.23-2.35), long-term use of an indwelling catheter (OR = 3.03; 95%CI: 1.59-6.59), a ureteral stent (OR = 1.54; 95%CI: 1.16-2.06), diabetes (OR = 1.17; 95%CI: 0.97-1.41), hypertension (OR = 1.6; 95%CI: 1.26-2.28), acute rejection process (OR = 2.22; 95%CI: 1.45-3.4), and abnormal urinary tract anatomy (OR = 2.87; 95%CI 1.44-5.74). CONCLUSION This meta-analysis revealed that UTIs are a significant problem in kidney recipients. Factors such as female sex, old age, history of UTIs, deceased donor, long-term use of an indwelling catheter, diabetes, acute rejection process, use of ureteral stent, abnormal urinary tract anatomy, and hypertension were related to an increased risk of UTIs in kidney recipients.
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Affiliation(s)
- Masoumeh Hosseinpour
- Faculty of Medical Sciences, Tabriz Branch, Islamic Azad University, Tabriz, Iran
| | - Aiyoub Pezeshgi
- Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, 83153-45139, IR, Iran
| | | | - Foroogh Sabzghabaei
- Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Hajishah
- Student Research Committee, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Soheila Mahdavynia
- Firoozabadi Clinical Research Development Unit (FACRDU), Iran University of Medical Sciences, Tehran, Iran.
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Krawczyk B, Wysocka M, Michalik M, Gołębiewska J. Urinary Tract Infections Caused by K. pneumoniae in Kidney Transplant Recipients – Epidemiology, Virulence and Antibiotic Resistance. Front Cell Infect Microbiol 2022; 12:861374. [PMID: 35531341 PMCID: PMC9068989 DOI: 10.3389/fcimb.2022.861374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/23/2022] [Indexed: 12/11/2022] Open
Abstract
Urinary tract infections are the most common complication in kidney transplant recipients, possibly resulting in the deterioration of a long-term kidney allograft function and an increased risk of recipient’s death. K. pneumoniae has emerged as one of the most prevalent etiologic agents in the context of recurrent urinary tract infections, especially with multidrug resistant strains. This paper discusses the epidemiology and risk factors associated with urinary tract infections in kidney transplant recipients, multi-drug resistance of K. pneumoniae (ESBL, KPC, NDM), treatment and pathogenesis of K. pneumoniae infections, and possible causes of recurrent UTIs. It also addresses the issue of colonization/becoming a carrier of K. pneumoniae in the gastrointestinal tract and asymptomatic bacteriuria in relation to a symptomatic UTI development and epidemiology.
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Affiliation(s)
- Beata Krawczyk
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
- *Correspondence: Beata Krawczyk,
| | - Magdalena Wysocka
- Department of Molecular Biotechnology and Microbiology, Faculty of Chemistry, Gdańsk University of Technology, Gdańsk, Poland
| | | | - Justyna Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Urinary Tract Infections in the First 6 Months after Renal Transplantation. Int J Nephrol 2021; 2021:3033276. [PMID: 34820141 PMCID: PMC8608522 DOI: 10.1155/2021/3033276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 09/04/2021] [Accepted: 09/30/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Urinary tract infections (UTIs) are common in the first 6 months after renal transplantation, and there are only limited data about UTIs after transplantation in Saudi Arabia in general. Methods A retrospective study from January 2017 to May 2020 with 6-month follow-up. Results 279 renal transplant recipients were included. Mean age was 43.4 ± 16.0 years, and114 (40.9%) were women. Urinary stents were inserted routinely during transplantation and were removed 35.3 ± 28 days postoperatively. Ninety-seven patients (35%) developed urinary tract infections (UTIs) in the first six months after renal transplantation. Of those who developed the first episode of UTI, the recurrence rates were 57%, 27%, and 14% for having one, two, or three recurrences, respectively. Late urinary stent removals, defined as more than 21 days postoperatively, tended to have more UTIs (OR: 1.43, P: 0.259, CI: 0.76–2.66). Age >40, female gender, history of neurogenic bladder, and transplantation abroad were statistically significant factors associated with UTIs and recurrence. Diabetes, level of immunosuppression, deceased donor renal transplantation, pretransplant residual urine volume, or history of vesicoureteral reflux (VUR) was not associated with a higher incidence of UTIs. UTIs were asymptomatic in 60% but complicated with bacteremia in 6% of the cases. Multidrug resistant organisms (MDROs) were the causative organisms in 42% of cases, and in-hospital treatment was required in about 50% of cases. Norfloxacin + Bactrim DD (160/800 mg) every other day was not associated with the lower risk of developing UTIs compared to the standard prophylaxis daily Bactrim SS (80/400 mg). Conclusion UTIs and recurrence are common in the first 6 months after renal transplantation. Age >40, female gender, neurogenic bladder, and transplantation abroad are associated with the increased risk of UTIs and recurrence. MDROs are common causative organisms, and hospitalization is frequently required. Dual prophylactic antibiotics did not seem to be advantageous over the standard daily Bactrim.
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Asymptomatic bacteriuria and urinary tract infections in kidney transplant recipients. Curr Opin Infect Dis 2021; 33:419-425. [PMID: 33148983 DOI: 10.1097/qco.0000000000000678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Urinary tract infection (UTI) is the most common infection in kidney transplant recipients (KTRs). Several elements increase the risk of UTI and/or modify its clinical presentation among KTRs (e.g. immunosuppressive therapy, kidney allograft denervation, and use of urinary catheters). Also, KTRs may have UTIs because of difficult-to-identify and/or difficult-to-treat organisms. We provide an overview of the current knowledge regarding bacterial UTIs in KTRs, with a focus on recent findings. RECENT FINDINGS There is accumulating evidence from clinical trials that screening for and treating asymptomatic bacteriuria is not beneficial in most KTRs (i.e. those who are ≥1-2 months posttransplant and do not have a urinary catheter). These patients have a point-prevalence of asymptomatic bacteriuria of only 3% and treating asymptomatic bacteriuria probably does not improve their outcomes. There is no clinical trial evidence to guide the management of symptomatic UTI in KTRs. Several important clinical questions remain unanswered, especially regarding the management of posttransplant pyelonephritis and the prevention of UTI in KTRs. SUMMARY Despite its frequency and associated morbidity, UTI after kidney transplantation is an understudied infection. In an era of increasing antimicrobial resistance and limited resources, further research is needed to ensure optimal use of antimicrobials in KTRs with UTI.
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Arpali E, Karatas C, Akyollu B, Akinci S, Gunaydin B, Sal O, Nayir A, Kocak B. Risk factors for febrile urinary tract infections in the first year after pediatric renal transplantation. Pediatr Transplant 2020; 24:e13637. [PMID: 31880402 DOI: 10.1111/petr.13637] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 10/24/2019] [Accepted: 11/27/2019] [Indexed: 01/24/2023]
Abstract
Urinary tract infection is the most common infectious complication following kidney transplant. Anatomic abnormalities, bladder dysfunction, a positive history of febrile urinary tract infection, and recipient age are reported risk factors. The aim of this study was to determine the risk factors for fUTI, which necessitated hospitalization in the first year after renal transplantation in our pediatric transplant population. A retrospective review of 195 pediatric patients who underwent kidney transplant between 2008 and 2017 from a single institution was performed. All patients admitted to the hospital with fUTI were marked for further analyses. The risk factors including age, gender, dialysis type, history of urologic disorders, and preoperative proteinuria for fUTI in the first year after kidney transplantation and graft survivals were investigated. Independent-sample t test and chi-square tests were used for univariate analysis. Exhaustive CHAID algorithm was used for multivariate analysis. The data of 115 male and 80 female patients were retracted. The mean ages of our cohort for males and females were 9.5 ± 5.1 and 10 ± 4.8 years, respectively. The age of the patients at transplant and their gender were found to be a statistically significant risk factors for developing fUTIs. Multivariate analysis showed that fUTI was common in female patients and a subgroup of male patients who had preoperative proteinuria, but no neurogenic bladder had higher risk compared with male patients without proteinuria. Patient surveillance and antibiotic prophylaxis algorithms can be developed to prevent febrile urinary tract infections seen after pediatric kidney transplantation in risky population.
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Affiliation(s)
- Emre Arpali
- Organ Transplant Center, Koç University Hospital, Istanbul, Turkey
| | - Cihan Karatas
- Organ Transplant Center, Koç University Hospital, Istanbul, Turkey
| | - Basak Akyollu
- Organ Transplant Center, Koç University Hospital, Istanbul, Turkey
| | - Serkan Akinci
- Department of Urology, Memorial Hizmet Hospital, Istanbul, Turkey
| | - Bilal Gunaydin
- Department of Urology, Nigde Omer Halisdemir University, Nigde, Turkey
| | - Oguzhan Sal
- Organ Transplant Center, Koç University Hospital, Istanbul, Turkey
| | - Ahmet Nayir
- Department of Pediatric Nephrology, Istanbul University School of Medicine, Istanbul, Turkey
| | - Burak Kocak
- Organ Transplant Center, Koç University Hospital, Istanbul, Turkey
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Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, Leone M, Lepape A, Mimoz O, Montravers P, Pourriat JL. Antibioprophylaxie en chirurgie et médecine interventionnelle (patients adultes). Actualisation 2017. ANESTHÉSIE & RÉANIMATION 2019. [DOI: 10.1016/j.anrea.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Martin C, Auboyer C, Boisson M, Dupont H, Gauzit R, Kitzis M, Leone M, Lepape A, Mimoz O, Montravers P, Pourriat J. Antibioprophylaxis in surgery and interventional medicine (adult patients). Update 2017. Anaesth Crit Care Pain Med 2019; 38:549-562. [DOI: 10.1016/j.accpm.2019.02.017] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Goldman JD, Julian K. Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13507. [PMID: 30793386 DOI: 10.1111/ctr.13507] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 01/05/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of urinary tract infections (UTI) in solid organ transplantation, focusing on kidney transplant (KT) recipients. KT recipients have unique risk factors for UTI, including indwelling stents and surgical manipulation of the genitourinary tract. KT recipients experience multi-drug antibiotic-resistant infections-UTI prevention and management strategies must consider risks of antimicrobial resistance. Non-antimicrobial prevention strategies for UTI in KT recipients are reviewed. It is important to recognize that some renal transplant recipients with UTI may primarily present with fever, malaise, leukocytosis, or a non-specific sepsis syndrome without symptoms localized to the urinary tract. However, asymptomatic bacteriuria (AB) must be distinguished from UTI because AB is not necessarily a disease state. Accumulating data indicate that there are no benefits of antibiotics for treatment of AB in KT recipients more than 2 months after post-transplant. Further research is needed on management of AB in the early (<2 months) post-transplant period, prophylaxis for UTI in this era of antibiotic resistance, recurrent UTI, non-antimicrobial prevention of UTI, and uropathogens identified in donor urine and/or preservative fluid cultures.
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Affiliation(s)
- Jason D Goldman
- Division of Infectious Diseases, Swedish Medical Center, Seattle, Washington.,Division of Infectious Diseases, University of Washington, Seattle, Washington
| | - Kathleen Julian
- Division of Infectious Diseases, Penn State Hershey Medical Center, Hershey, Pennsylvania
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9
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Soylu L, Aydin OU, Atli M, Gunt C, Ekmekci Y, Cekmen N, Karademir S. Does early removal of double J stents reduce urinary infection in living donor renal transplantation? Arch Med Sci 2019; 15:402-407. [PMID: 30899293 PMCID: PMC6425203 DOI: 10.5114/aoms.2018.73524] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/24/2018] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Prophylactic use of double J (DJ) stents in recipients is highly accepted in renal transplantation. In this study, the association between the frequency of urologic complications (UC) and urinary tract infections (UTI), and the early or late removal of DJ stents was investigated. MATERIAL AND METHODS A total of 116 live-donor renal transplant patients were included in the study during a 4-year period, with a mean follow-up of 29.2 ±15.3 months. In all, DJ stents were used. All patients were clinically monitored for graft function by assessment of the complete blood count, renal biochemistry, urine analysis and blood drug level according to our follow-up protocol. RESULTS The patients were divided into 2 groups according to the time of their stent removal: group I (n = 44), removal within the first 14 days; and group II (n = 72), removal after 14 days. No urinary leaks were detected in either of the groups. Three patients suffered from anastomotic stricture (group I, n = 1; group II, n = 2). The rates of UTI were similar in groups I and II (13.6% vs. 16.6%, respectively, p = 0.79). The rate of UTI in women was found to be 3.8 times higher than in men. CONCLUSIONS The results of our study demonstrated that DJ stent removal within 14 days did not reduce the risk of UTI when compared to stent removal after 14 days. Similar effects on complication rates for ureteral stenting for these 2 removal periods were observed.
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Affiliation(s)
- Lutfi Soylu
- Department of General Surgery and Organ Transplantation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Oguz Ugur Aydin
- Department of General Surgery and Organ Transplantation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Muzaffet Atli
- Department of General Surgery and Organ Transplantation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Ceren Gunt
- Department of Anesthesiology and Reanimation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Yakup Ekmekci
- Department of Nephrology, Ankara Güven Hastanesi, Ankara, Turkey
| | - Nedim Cekmen
- Department of Anesthesiology and Reanimation, Ankara Güven Hastanesi, Ankara, Turkey
| | - Sedat Karademir
- Department of General Surgery and Organ Transplantation, Ankara Güven Hastanesi, Ankara, Turkey
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Sarier M, Demir M, Goktas S, Duman I, Buyukkinaci M, Yuksel Y, Tekin S, Yavuz AH, Sengul A. Results of Real-time Multiplex Polymerase Chain Reaction Assay in Renal Transplant Recipients With Sterile Pyuria. Transplant Proc 2018; 49:1307-1311. [PMID: 28735999 DOI: 10.1016/j.transproceed.2017.02.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/07/2017] [Indexed: 12/17/2022]
Abstract
Urinary tract infections are a major cause of morbidity and hospitalization after renal transplantation. Patients treated with immunosuppressive drugs suffer not only from common uropathogens but also from opportunistic infections caused by unusual uropathogens. Sterile pyuria is associated with numerous infectious agents including viruses, fungi, and atypical or fastidious organisms. The objective of this study was to investigate the pathogens using real-time multiplex polymerase chain reaction (rtMPCR) assay in sterile pyuria of renal transplant recipients. In this prospective controlled study, pathogen detection was performed with rtMPCR assay on October 2016 in 60 patients with sterile pyuria who had undergone kidney transplantation. A total of 40 renal transplant patients were determined as the control group. Male-to-female ratio was same. The mean age of the subjects with sterile pyuria was 45.7 ± 12.1 (25-74). The mean duration after transplantation was 28.8 ± 3.97 (3-102) months. Pathogens were detected with rtMPCR in 61.7% of sterile pyuria group. This rate was significantly higher compared with the control group (P < .001). Two or more different pathogens were found in 13 (21.7%) patients in sterile pyuria group. The pathogens found included cytomegalovirus in 10 patients (19%), Gardnerella vaginalis and obligate anaerobes in 20 patients (38%), Ureaplasma spp in 17 patients (33%), Candida spp in 2 patients (4%), Mycoplasma hominis in one patient (2%), herpes simplex virus-2 in one patient (2%), and Trichomonas vaginalis in one patient (2%). Sterile pyuria may indicate the presence of genitourinary pathogens that cannot be detected with conventional urine culture method in renal transplantation patients. rtMPCR is an accurate and convenient method for detection of multiple potential pathogens of sterile pyuria in renal transplant patients.
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Affiliation(s)
- M Sarier
- Department of Urology, Kemerburgaz University Medical Faculty, İstanbul, Turkey.
| | - M Demir
- Department of Biochemistry, Kemerburgaz University Medical Faculty, İstanbul Turkey
| | - S Goktas
- Department of Clinical Microbiology and Infectious Disease, Gelişim Medical Laboratories, İstanbul, Turkey
| | - I Duman
- Department of Urology, Kemerburgaz University Medical Faculty, İstanbul, Turkey
| | - M Buyukkinaci
- Department of Obstetrics and Gynecology, Medical Park Hospital, Antalya, Turkey
| | - Y Yuksel
- Department of Transplantation Unit, Medical Park Hospital, Antalya, Turkey
| | - S Tekin
- Department of Surgery, Kemerburgaz University, İstanbul, Turkey
| | - A H Yavuz
- Department of Transplantation Unit, Medical Park Hospital, Antalya, Turkey
| | - A Sengul
- Department of Clinical Microbiology and Infectious Disease, Medical Park Hospital, Antalya, Turkey
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Hollyer I, Ison MG. The challenge of urinary tract infections in renal transplant recipients. Transpl Infect Dis 2018; 20:e12828. [PMID: 29272071 DOI: 10.1111/tid.12828] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 12/13/2017] [Accepted: 12/15/2017] [Indexed: 12/11/2022]
Abstract
Urinary tract infections (UTI) are an important cause of morbidity and mortality in renal transplant patients. These infections are quite common, and the goal of care is to identify and reduce risk factors while providing effective prophylaxis and treatment. Better understanding of long-term outcomes from these infections has led to the distinctions among UTI, recurrent UTI, and asymptomatic bacteriuria (ASB), and that each requires a different therapeutic approach. Specifically, new research has supported the perspective that asymptomatic bacteriuria should not be treated. Symptomatic UTI, on the other hand, requires intervention and remains an ongoing challenge for infectious disease clinicians. Many bacteria species are responsible for UTI in renal transplant patients, and in recent years there has been a global rise in infection caused by bacteria with newly acquired antibacterial resistance genes. Many renal transplant patients who experience UTI will also have multiple recurring episodes, which likely has a distinct pathophysiological mechanism leading to chronic colonization of the urinary tract. In these cases, long-term management includes bacterial suppression, which aims to reduce rather than eliminate bacteria to levels below the threshold for symptomatic infection. This review will address the current understanding of UTI epidemiology, pathogenesis, and risk factors in the renal transplant community, and also focus on current prevention and treatment strategies for patients who face an environment of increasingly antibiotic-resistant bacteria.
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Affiliation(s)
- Ian Hollyer
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael G Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Thölking G, Schuette-Nuetgen K, Vogl T, Dobrindt U, Kahl BC, Brand M, Pavenstädt H, Suwelack B, Koch R, Reuter S. Male kidney allograft recipients at risk for urinary tract infection? PLoS One 2017; 12:e0188262. [PMID: 29145515 PMCID: PMC5690643 DOI: 10.1371/journal.pone.0188262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/05/2017] [Indexed: 12/31/2022] Open
Abstract
Background Urinary tract infection (UTI) is the most common infection after renal transplantation (RTx). Although female sex is a well-known risk factor for the development of UTI after RTx, the role of the donor sex in this context remains unclear. Methods In this case control study 6,763 RTx cases were screened for UTI when presenting at our transplant outpatient clinics. 102 different RTx patients fulfilled the inclusion criteria and were compared to 102 controls. Data on renal function was prospectively followed for 12 months. Results were compared to a previous RTx cohort from our transplant center. Additionally, we assessed the immunological response of leukocytes from 58 kidney recipients and 16 controls to lipopolysaccharide stimulation. Result After identification by univariate analysis, multivariate logistic regression analysis indicated female sex, minor height, advanced age and male kidney allograft sex to be associated with the occurrence of UTI after RTx. Female recipients who received male grafts had the best renal function 12 months after presentation. However, leukocyte response of recipients to lipopolysaccharide was impaired irrespective of donor and recipient sex to the same extend. Conclusions We conclude from our data that male kidney allografts are associated with the occurrence of UTI after RTx but did not influence the response of leukocytes to lipopolysaccharide. Further prospective studies are needed to identify the underlying mechanisms of higher male kidney donor dependent UTI.
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Affiliation(s)
- Gerold Thölking
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
- * E-mail:
| | - Katharina Schuette-Nuetgen
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Ulrich Dobrindt
- Institute of Hygiene, University of Münster, Münster, Germany
| | - Barbara C. Kahl
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Marcus Brand
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Hermann Pavenstädt
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Barbara Suwelack
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
| | - Raphael Koch
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Stefan Reuter
- Department of Medicine D, Division of General Internal Medicine, Nephrology and Rheumatology, University Hospital Münster, Münster, Germany
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Recurrence of urinary tract infections and development of urinary-specific antibiogram for kidney transplant recipients. J Glob Antimicrob Resist 2017; 12:119-123. [PMID: 28859935 DOI: 10.1016/j.jgar.2017.08.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES Urinary tract infection (UTI) recurrence and antimicrobial resistance remain a common problem in kidney transplant recipients. Whilst the use of annual institutional antibiograms may help guide appropriate empirical antibiotic selection, these non-disease specific antibiograms do not always account for patient-specific risk factors or disease-specific resistance patterns. This study determined the frequency of UTI recurrence during the first year after kidney transplantation as well as differences in antimicrobial susceptibility between an institutional antibiogram and the disease-specific antibiogram for patients following kidney transplantation. METHODS In this study, adult patients with at least one UTI during an inpatient admission within 1 year post kidney transplantation were evaluated. A disease-specific antibiogram for UTIs in kidney transplant recipients was prepared based on culture results and was compared with the annual institutional antibiograms. RESULTS Of 299 kidney transplants performed during the study period, 66 subjects meet the study inclusion criteria, of whom 47% had two or more UTIs within the first year after kidney transplant. In comparison with the institutional antibiogram, Escherichia coli isolated from urine samples from kidney transplant recipients were significantly more resistant to trimethoprim/sulfamethoxazole, ceftriaxone, cefepime, ciprofloxacin and gentamicin (P<0.0001). CONCLUSIONS Multiple UTIs are common in kidney transplant recipients during the first year post-transplantation. E. coli urinary isolates were significantly more resistant to multiple antibiotic drug classes in this patient population compared with the general hospital population. Antimicrobial stewardship programmes at transplant centres should consider producing disease-specific antibiograms specifically for transplant recipients to improve empirical antibiotic selection guidance.
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14
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Gozdowska J, Czerwińska M, Chabros Ł, Młynarczyk G, Kwiatkowski A, Chmura A, Durlik M. Urinary Tract Infections in Kidney Transplant Recipients Hospitalized at a Transplantation and Nephrology Ward: 1-Year Follow-up. Transplant Proc 2017; 48:1580-9. [PMID: 27496451 DOI: 10.1016/j.transproceed.2016.01.061] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION The aim of this study was to investigate risk factors for urinary tract infections (UTI), the causative organisms of UTI and also their management and treatment. In addition, we evaluated the effects of UTI on renal graft function. METHODS This analysis included 107 kidney transplant recipients (64% women) with a diagnosis of UTIs confirmed by positive results on urine culture. Type of pathogens, sensitivity to drugs, risk factors for infection, incidence of urosepsis, hospitalization period, treatment methods, and recurrence rates were analyzed. Statistical analysis was performed by using Pearson's χ(2) test, Yates' χ(2) test, the Student t test, Welch's t test, the Mann-Whitney U test, Fisher's exact test, and the Shapiro-Wilk normality test. RESULTS The most common species isolated from urine samples included Escherichia coli (42%), Klebsiella pneumoniae (15%), and Enterococcus faecalis (10%). The percentage of multidrug-resistant strains was 31%, and urosepsis was diagnosed in 16% of patients. Recurrences developed in 76% of infected patients. Bricker ureterointestinal anastomosis was performed in 11% of patients. Risk factors for severe infections included: pre-transplantation urinary tract surgery (P = .02), double-J stent insertion (more common in men) during KTx (N = 34; 32%), (P = .021), reoperations following transplantation (P = .36), elevated tacrolimus levels at the time of infection (P = .024). Severe infections were diagnosed in patients with lower eGFRs, were associated with a need for longer hospitalization (P = .04) and escalation of antibacterial treatment. Carbapenems were used in 22 patients (20.5%). CONCLUSIONS UTIs were more common in women, in patients with impaired function of the kidney transplant, and in those with a history of urinary tract interventions. Severe infections were associated with a risk of urosepsis, longer hospitalization, and a need for escalation of antibiotic treatment.
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Affiliation(s)
- J Gozdowska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland.
| | - M Czerwińska
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Ł Chabros
- Chair and Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - G Młynarczyk
- Chair and Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - A Kwiatkowski
- Chair and Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - A Chmura
- Chair and Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplantation Medicine, Nephrology and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
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15
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Wu X, Dong Y, Liu Y, Li Y, Sun Y, Wang J, Wang S. The prevalence and predictive factors of urinary tract infection in patients undergoing renal transplantation: A meta-analysis. Am J Infect Control 2016; 44:1261-1268. [PMID: 27311513 DOI: 10.1016/j.ajic.2016.04.222] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are the main cause of infectious complications in renal transplant (RTx) recipients and are considered as a potential risk factor for poorer graft outcomes. However, the risk factors of UTIs are controversial. We estimated the incidence and predisposing factors of UTIs in patients undergoing RTx. METHODS Seventeen studies (6,671 patients) evaluated the prevalence and the risk factors of UTIs in patients with RTx published January 2000-October 2014 were included. The data were pooled using the fixed effect model or DerSimonian-Laird random effect model according to I2. RESULTS Thirteen eligible articles with a total of 3,364 patients were evaluated and the pooled prevalence of UTIs was 38.0% (95% confidence interval [CI], 29%-47%; P < .01). The estimated risk factors for UTI include female sex (odds ratio [OR], 3.11; 95% CI, 2.10-4.13), older age (OR, 1.032; 95% CI, 1.01-1.04), duration of catheter (OR, 1.52; 95% CI, 1.03-2.03), acute rejection episodes (OR, 1.64; 95% CI, 1.11-2.41), and receiving a kidney from a deceased donor (OR, 1.28; 95% CI, 1.09-1.52). CONCLUSIONS More than one-third of RTx patients had at least 1 UTI after surgery. Female sex, older age of the recipient, long duration of catheter, acute rejection episodes, and cadaveric donor were associated with higher risk of UTI.
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Affiliation(s)
- Xiaohui Wu
- Division of Hospital Infection Management, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Yanyan Dong
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yunhong Liu
- School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Yingxia Li
- Department of Intensive Care, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yu Sun
- Department of Gastrointestinal Surgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Jingna Wang
- Department of Neonatology, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Shuihui Wang
- Division of Hospital Infection Management, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
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Singh R, Geerlings SE, Peters-Sengers H, Idu MM, Hodiamont CJ, Ten Berge IJM, Bemelman FJ. Incidence, risk factors, and the impact of allograft pyelonephritis on renal allograft function. Transpl Infect Dis 2016; 18:647-660. [PMID: 27380002 DOI: 10.1111/tid.12568] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/30/2015] [Accepted: 04/03/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The impact of allograft pyelonephritis (AGPN) on renal allograft function is controversial. In this study, we evaluated the incidence, risk factors, and the impact of AGPN on renal allograft function. METHODS Retrospective cohort study in adult renal allograft recipients with 1-year follow-up after transplantation (Tx). Renal allograft function was evaluated by estimated glomerular filtration rate (eGFR) (by Modification of Diet in Renal Disease formula) and 24-h urine protein excretion. RESULTS A total of 431 renal allograft recipients were analyzed; 57 (13.2%) developed AGPN within 1 year after Tx. Median time between Tx and AGPN was 50 days. Risk factors for AGPN were the presence of a urological catheter (odds ratio [OR] = 18.93, 95% confidence interval [CI] = 8.00-44.81, P < 0.001) and preceding asymptomatic bacteriuria (ASB) (OR = 2.16, 95% CI = 1.20-3.90, P = 0.009). In 72.7%, the causative microorganism of ASB was identical to that of the succeeding AGPN episode. Multivariable linear regression analysis showed that experiencing AGPN did not decrease the eGFR (P = 0.61) nor did increased proteinuria (P = 0.29) 1 year after Tx. For the eGFR, an interaction was found between AGPN/bacteriuria (BU) and acute rejection (AR): the group experiencing BU preceding AR had significantly (P < 0.001) lower eGFR compared with the group that experienced only AR (21 mL/min/1.73 m2 vs. 48 mL/min/1.73 m2 ), as a result of increased prevalence of combined rejections within the BU group. CONCLUSION Indwelling urological catheters and preceding ASB are associated with developing AGPN. An incident of AGPN itself does not impair renal allograft function 1 year after Tx. However, a relevant interaction occurs between BU and AR, in which the sequence of occurrence of these 2 events synergistically impairs the eGFR.
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Affiliation(s)
- R Singh
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
| | - S E Geerlings
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - H Peters-Sengers
- Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - M M Idu
- Division of Vascular Surgery, Department of Surgery, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - C J Hodiamont
- Department of Medical Microbiology, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - I J M Ten Berge
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
| | - F J Bemelman
- Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands
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Khorvash F, Mortazavi M, Hakamifard A, Ataei B. Comparison of the effect of co-trimoxazole and co-trimoxazole plus ciprofloxacin in urinary tract infection prophylaxis in kidney transplant patients. Adv Biomed Res 2016; 5:108. [PMID: 27376047 PMCID: PMC4918205 DOI: 10.4103/2277-9175.183669] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/30/2016] [Indexed: 11/10/2022] Open
Abstract
Background: Urinary tract infection (UTI) as an important infection in the setting of renal transplantation carries the high mortality and morbidity rate. Thus, the prevention of this infection should receive higher priority. However, bacterial resistance to antibiotics is on the rise, with limited data to guide prophylaxis. The purpose of this study was to compare the effect of sulfamethoxazole-trimethoprim (SMZ/TMP) and SMZ/TMP plus ciprofloxacin for prophylaxis of UTI in renal transplant recipients. Materials and Methods: In a clinical trial study, 50 patients were included and divided into two groups of 25 using block randomization. Patients in Group I received prophylactic SMZ/TMP and those in Group II received ciprofloxacin plus SMZ/TMP. The incidence of UTI in the two groups at 1, 3, and 6 months after transplantation was evaluated. This study was registered in Iranian Registry of Clinical Trial (IRCT number: IRCT 2015120823743N1). Results: Of the 61 patients older than 18 years at the time of transplantation, 50 were included. UTI was documented in 8 patients (32%) in Group I and 3 (12%) in Group II (P = 0.026). The average time for the development of the first case of infection was the same for both groups (P = 0.241), and it was at its maximum in the 1st month. Urinary infections caused by Escherichia coli, the dominant strain, were the same in both groups (P = 0.673). Conclusions: Our study shows that the addition of 1 month course of ciprofloxacin lowered the incidence of UTI. More studies are needed to confirm the efficacy of this approach.
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Affiliation(s)
- Farzin Khorvash
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Mortazavi
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behrooz Ataei
- Department of Infectious Diseases, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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18
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Singh R, Bemelman FJ, Hodiamont CJ, Idu MM, Ten Berge IJM, Geerlings SE. The impact of trimethoprim-sulfamethoxazole as Pneumocystis jiroveci pneumonia prophylaxis on the occurrence of asymptomatic bacteriuria and urinary tract infections among renal allograft recipients: a retrospective before-after study. BMC Infect Dis 2016; 16:90. [PMID: 26912326 PMCID: PMC4766656 DOI: 10.1186/s12879-016-1432-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 02/15/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The international guidelines recommend the administration of trimethoprim-sulfamethoxazole (TMP-SMX) as Pneumocystis jiroveci pneumonia (PJP) prophylaxis for six months after transplantation. The aim of this study is to evaluate the influence of TMP-SMX prophylaxis on the occurrence of asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) as cystitis and allograft pyelonephritis (AGPN) and its impact on the antimicrobial resistance pattern of causative microorganisms. METHODS We have conducted a retrospective before-after study in adult renal allograft recipients with one year follow-up after transplantation. We compared the ("after") group that received TMP-SMX as PJP prophylaxis to the ("before") group that did not receive it. RESULTS In total, 343 renal allograft recipients were analysed, of whom 212 (61.8 %) received TMP-SMX as PJP prophylaxis. In this study, 63 (18.4 %) did only develop ASB without UTI, 26 (7.6 %) developed cystitis and 43 (12.5 %) developed AGPN. The remaining 211 (61.5 %) renal allograft recipients did not develop any bacteriuria at all. Multivariable Cox proportional regression analysis indicated that TMP-SMX as PJP prophylaxis was not associated with reduced prevalence of ASB (Hazard ratio (HR) = 1.52, 95 % CI = 0.79-2.94, p = 0.213), nor with reduced incidence of cystitis (HR = 2.21, 95 % CI = 0.76-6.39, p = 0.144), nor AGPN (HR = 1.12, 95 % CI = 0.57-2.21, p = 0.751). Among the group receiving TMP-SMX as PJP prophylaxis there was a trend was observed in increase of both amoxicillin (86 % versus 70 %) and TMP-SMX (89 % versus 48 %) resistance which already appeared within the first 30 days after TMP-SMX exposure. CONCLUSIONS Among renal allograft recipients, administration of TMP-SMX as PJP prophylaxis does not prevent ASB nor UTI, however it is associated with tendency towards increased amoxicillin and TMP-SMX resistance.
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Affiliation(s)
- Ramandeep Singh
- Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Frederike J Bemelman
- Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Caspar J Hodiamont
- Department of Medical Microbiology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Mirza M Idu
- Department of Surgery, Division of Vascular Surgery, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Ineke J M Ten Berge
- Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Suzanne E Geerlings
- Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center-University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands.
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Lofaro D, Vogelzang JL, van Stralen KJ, Jager KJ, Groothoff JW. Infection-related hospitalizations over 30 years of follow-up in patients starting renal replacement therapy at pediatric age. Pediatr Nephrol 2016; 31:315-23. [PMID: 26463555 PMCID: PMC4689769 DOI: 10.1007/s00467-015-3209-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/29/2015] [Accepted: 08/12/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Pediatric renal replacement therapy (RRT) patients surviving long-term are at a much higher risk of mortality compared with the age-matched general population. Recently, we demonstrated a transition from cardiovascular disease to infection as the main cause of death in a long-term follow-up study of pediatric RRT. Here, we explore the burden of infections requiring hospitalization over 30 years of follow-up on RRT. METHODS The cohort comprised all 234 Dutch patients on RRT under 15 years of age between 1972 and 1992. We analyzed infection-related hospitalizations during the period 1980–2010. We evaluated the Hospital Admission Rate (HAR) per patient-years (py) and infectious over noninfectious HAR ratio (HARR). RESULTS The HAR decreased significantly over time for all patients. The rate of hemodialysis-related infections decreased between 1980 and 1999, but stabilized during 2000–2010, whereas peritoneal dialysis-related infections decreased progressively. Transplantation-related infections did not change, except for urinary tract infections (UTIs), which increased significantly from 3.3/100 py [95%CI 3.2–3.4] in 1980–1989 to 4.4/100 py [4.2–4.5] in 2000–2010 (p <0.001). The contribution of infection to HAR increased significantly in transplanted patients (HARR: 1980–1989: 0.25 [0.2–0.3]; 2000–2010: 1.0 [0.79–1.27], p <0.001). CONCLUSIONS Our findings indicate a relative increase in infections requiring hospitalization over time in patients starting RRT during the pediatric age, especially severe UTIs in transplantation. More attention paid to urological abnormalities in cases of recurrent UTI and tailored adjustment of immunosuppression may reduce risk in these patients.
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Affiliation(s)
- Danilo Lofaro
- />Kidney and Transplantation Research Centre, Department of Nephrology, Dialysis and Transplantation, Annunziata Hospital, Via F. Migliori, 87100 Cosenza, Italy
| | - Judith L. Vogelzang
- />Department of Pediatric Nephrology, Academic Medical Center, Emma Children’s Hospital, Amsterdam, The Netherlands
| | - Karlijn J van Stralen
- />ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kitty J. Jager
- />ERA-EDTA Registry and ESPN/ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap W. Groothoff
- />Department of Pediatric Nephrology, Academic Medical Center, Emma Children’s Hospital, Amsterdam, The Netherlands
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20
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Asymptomatic bacteriuria and urinary tract infections among renal allograft recipients. Curr Opin Infect Dis 2015; 28:112-6. [DOI: 10.1097/qco.0000000000000120] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Wolters H, Palmes D, Lordugin E, Bahde R, Senninger N, Hölzen JP, Kebschull L. Antibiotic Prophylaxis at Urinary Catheter Removal Prevents Urinary Tract Infection After Kidney Transplantation. Transplant Proc 2014; 46:3463-5. [DOI: 10.1016/j.transproceed.2014.04.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 03/26/2014] [Accepted: 04/22/2014] [Indexed: 11/25/2022]
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23
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Prophylactic Ciprofloxacin for Kidney Transplant Recipients—To Add or Not To Add. Transplantation 2013; 96:370-1. [DOI: 10.1097/tp.0b013e31829e2723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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