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Schreiber PW, Hoessly LD, Boggian K, Neofytos D, van Delden C, Egli A, Dickenmann M, Hirzel C, Manuel O, Koller M, Rossi S, Banz V, Schmied B, Guerke L, Matter M, de Rougemont O, Bonani M, Golshayan D, Schnyder A, Sidler D, Haidar F, Kuster SP, Stampf S, Mueller NJ. Surgical site infections after kidney transplantation are independently associated with graft loss. Am J Transplant 2024; 24:795-802. [PMID: 38042413 DOI: 10.1016/j.ajt.2023.11.013] [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: 05/03/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 12/04/2023]
Abstract
Surgical site infections (SSIs) are common health care-associated infections. SSIs after kidney transplantation (K-Tx) can endanger patient and allograft survival. Multicenter studies on this early posttransplant complication are scarce. We analyzed consecutive adult K-Tx recipients enrolled in the Swiss Transplant Cohort Study who received a K-Tx between May 2008 and September 2020. All data were prospectively collected with the exception of the categorization of SSI which was performed retrospectively according to the Centers for Disease Control and Prevention criteria. A total of 58 out of 3059 (1.9%) K-Tx recipients were affected by SSIs. Deep incisional (15, 25.9%) and organ/space infections (34, 58.6%) predominated. In the majority of SSIs (52, 89.6%), bacteria were detected, most frequently Escherichia coli (15, 28.9%), Enterococcus spp. (14, 26.9%), and coagulase-negative staphylococci (13, 25.0%). A BMI ≥25 kg/m2 (multivariable OR 2.16, 95% CI 1.07-4.34, P = .023) and delayed graft function (multivariable OR 2.88, 95% CI 1.56-5.34, P = .001) were independent risk factors for SSI. In Cox proportional hazard models, SSI was independently associated with graft loss (multivariable HR 3.75, 95% CI 1.35-10.38, P = .011). In conclusion, SSI was a rare complication after K-Tx. BMI ≥25 kg/m2 and delayed graft function were independent risk factors. SSIs were independently associated with graft loss.
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Affiliation(s)
- Peter W Schreiber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University Zurich, Zurich, Switzerland.
| | - Linard D Hoessly
- Clinic for Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland
| | - Katia Boggian
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Dionysios Neofytos
- Transplant Infectious Diseases Unit, Service of Infectious Diseases, University Hospitals Geneva, University of Geneva, Geneva, Switzerland
| | - Christian van Delden
- Transplant Infectious Diseases Unit, Service of Infectious Diseases, University Hospitals Geneva, University of Geneva, Geneva, Switzerland
| | - Adrian Egli
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Michael Dickenmann
- Clinic for Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland
| | - Cédric Hirzel
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland; Transplantation Center, University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Michael Koller
- Clinic for Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland
| | - Simona Rossi
- Clinic for Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland
| | - Vanessa Banz
- University Clinic for Visceral Surgery and Medicine, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Bruno Schmied
- Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Lorenz Guerke
- Department of Vascular and Transplant Surgery, Basel University Hospital, Basel, Switzerland
| | - Maurice Matter
- Visceral Surgery Department, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Olivier de Rougemont
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Marco Bonani
- Division of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Déla Golshayan
- Transplantation Center, University Hospital of Lausanne (CHUV), Lausanne, Switzerland
| | - Aurelia Schnyder
- Clinic for Nephrology, Cantonal Hospital St. Gallen, St.Gallen, Switzerland
| | - Daniel Sidler
- Division of Nephrology and Hypertension, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Fadi Haidar
- Division of Nephrology, Department of Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Stefan P Kuster
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Susanne Stampf
- Clinic for Transplantation Immunology and Nephrology, Basel University Hospital, Basel, Switzerland
| | - Nicolas J Mueller
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University Zurich, Zurich, Switzerland
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Tarhini H, Waked R, Rahi M, Haddad N, Dorent R, Randoux C, Bunel V, Lariven S, Deconinck L, Rioux C, Yazdanpanah Y, Joly V, Ghosn J. Investigating infectious outcomes in adult patients undergoing solid organ transplantation: A retrospective single-center experience, Paris, France. PLoS One 2023; 18:e0291860. [PMID: 37797039 PMCID: PMC10553823 DOI: 10.1371/journal.pone.0291860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVES This study described the demographic characteristics, clinical presentation, treatment, and outcomes of solid organ transplant recipients who were admitted to our center for infection. It also determined factors associated with a poor outcome, and compares early and late period infections. METHODS In this retrospective observational study, conducted at a tertiary care center in France between October 2017 and March 2019, infectious outcomes of patients with solid organ transplant where studied. RESULTS A total of 104 patients were included with 158 hospitalizations for infection. Among these 104 patients, 71 (68%) were men. The median age was 59 years old. The most common symptoms on admission were fever (66%) and chills (31%). Lower respiratory tract infections were the most common diagnosis (71/158 hospitalizations). Urinary tract infections were frequently seen in kidney transplant recipients (25/60 hospitalizations). One or more infectious agents were isolated for 113 hospitalizations (72%): 70 bacteria, 36 viruses and 10 fungi, with predominance of gram-negative bacilli (53 cases) of which 13 were multidrug-resistant. The most frequently used antibiotics were third generation cephalosporins (40 cases), followed by piperacillin-tazobactam (26 cases). We note that 25 infections (16%) occurred during the first 6 months (early post-transplant period). Patients admitted during the early post-transplant period were more often on immunosuppressive treatment with prednisone (25/25 VS 106/133) (p = 0.01), mycophenolic acid (22/25 VS 86/133) (p = 0.03), presented for an urinary tract infection (10/25 VS 25/133) (p = 0.04) or a bacterial infection (17/25 VS 53/133) (p = 0.01). Patients with later infection had more comorbidities (57/83 VS 9/21) (p = 0.03), cancer (19/83 VS 0/21) (p = 0.04) or were on treatment with everolimus (46/133 VS 0/25) (p = 0.001). During 31 hospitalizations (20%), patients presented with a serious infection requiring intensive care (n = 26; 16%) or leading to death (n = 7; 4%). Bacteremia, pulmonary and cardiac complications were the main risk factors associated with poor outcome. CONCLUSION Infections pose a significant challenge in the care of solid organ transplant patients, particularly those with comorbidities and intensive immunosuppression. This underscores the crucial importance of continuous surveillance and epidemiologic monitoring within this patient population.
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Affiliation(s)
- Hassan Tarhini
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Rami Waked
- Division of Infectious Diseases, Maine Medical Center, Portland, ME, United States of America
| | - Mayda Rahi
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Nihel Haddad
- Service d’Hygiène Hospitalière, Pole Santé Publique, CHU Grenoble, La Tronche, France
| | - Richard Dorent
- Service de Chirurgie Cardiaque, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Christine Randoux
- Service de Néphrologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Vincent Bunel
- Service de Pneumologie, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Sylvie Lariven
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Laurene Deconinck
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Christophe Rioux
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Yazdan Yazdanpanah
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université Paris Cité, Infection Modélisation Antimicrobial Evolution (IAME), Inserm UMR1137, Paris, France
| | - Veronique Joly
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
| | - Jade Ghosn
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat Claude Bernard, AP-HP, Paris, France
- Université Paris Cité, Infection Modélisation Antimicrobial Evolution (IAME), Inserm UMR1137, Paris, France
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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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4
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Hafiz TA, Albloshi A, Alhumaidan OS, Mubaraki MA, Alyami AS, Alrashoudi R, Alrabiah MA, Alotaibi F. The Epidemiological Pattern, Resistance Characteristics and Clinical Outcome of Enterobacter cloacae: Recent Updates and Impact of COVID-19 Pandemic. Healthcare (Basel) 2023; 11:healthcare11030312. [PMID: 36766887 PMCID: PMC9914498 DOI: 10.3390/healthcare11030312] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 01/12/2023] [Accepted: 01/17/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES E. cloacae is an opportunistic organism that causes serious infections, particularly in immuno-compromised and hospitalized patients, along with the emergence of resistance traits. The COVID-19 pandemic has impacted the epidemiological pattern and resistance traits of E. cloacae infections as well as those of other bacteria. The study aims to assess the epidemiological patterns, resistance characteristics and clinical outcomes of E. cloacae in Saudi Arabia and the impact of the COVID-19 pandemic. METHODS King Fahad Medical City in Riyadh provided the data between January 2019 and December 2021 for the retrospective study of 638 isolates of E. cloacae. The clinical outcome of an E. cloacae infection was also determined by collecting and statistically analyzing the clinical records of 153 ICU patients. RESULTS The total percentage of resistant E. cloacae isolates decreased from 48.36% in 2019 to 38% in 2020 and 37.6% in 2021. The overall mortality rate among ICU patients was 40.5%, with an adult age group having a substantial relative risk value of 1.37. CONCLUSION E. cloacae is a prevalent nosocomial infection in which adult age is a significant risk factor for mortality. Moreover, this study emphasizes the importance of comparing E. cloacae resistance trends before and throughout the pandemic period in order to better understand the bacteria's behaviour.
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Affiliation(s)
- Taghreed A. Hafiz
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
- Correspondence:
| | - Alaa Albloshi
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ohoud S. Alhumaidan
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Murad A. Mubaraki
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ahmed S. Alyami
- Pathology and Clinical Laboratory Medicine, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Reem Alrashoudi
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Mona A. Alrabiah
- Microbiology and Immunology Department, King Khaled University Hospital, Riyadh 12372, Saudi Arabia
| | - Fawzia Alotaibi
- Pathology Department, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
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El Hennawy HM, Safar O, Al Faifi AS, Abdelaziz AA, Al Shehri AA, Al Atta E, Korkoman M, Mahedy A, Kamal AI, Mirza N, Al Shahrani M, Zaitoun MF, Elatreisy A, Shalkamy O, Al Sheikh K, Al Fageeh A, El Nazer W. Recurrent Urinary Tract Infection in Living Donor Renal Transplant Recipients and the Role of Behavioral Education Program in Management: A Single-Center Experience. Transplant Proc 2023; 55:103-108. [PMID: 36577635 DOI: 10.1016/j.transproceed.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 08/29/2022] [Accepted: 09/20/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are the most prevalent type of kidney transplant (KT) recipients. We aimed to investigate the incidence, causes, and clinical impact of early recurrent UTI post-living donor KT and to examine the role of behavioral education program in management. METHODS This retrospective cohort chart-review study included all KT recipients with recurrent UTI necessitating hospital admission between September 2017 and August 2021. All patients with recurrent UTI were subjected to behavioral education for a month. RESULTS UTI was found in 14 of 145 patients (9.6%), with recurrent UTI in 11 (7.6%). A total of 93% of UTIs occurred during the first 6 months post-transplant and represented 52% of KT readmissions during the same period. A total of 64.3% of patients were older than 50 years. The mean (SD) length of hospital stay was 5 (2.5) days, with an equal incidence in both sexes. The most common bacterial isolates in early recurrent UTI were Escherichia coli in 80.9%. Both Extended-spectrum beta-lactamases and multidrug-resistant organisms (resistance in ≥3 drugs) were seen in 82.4% of isolates. Furthermore, the most effective antibiotic was meropenem, with 86.7% effectiveness. A total of 65% of UTIs were managed with a single antibacterial course. A total of 64.3% of patients were older than 50 years. In patients who developed UTI, the mean (SD) serum creatinine was 1.31 (0.52) mg/dL, with a mean increase in serum creatinine of 0.19 mg/dL on having the episodes; at 1 year post-transplant, serum creatinine declined to 1.23 (0.43) mg/dL. Four patients (36%) had no recurrence of UTI after behavioral education. CONCLUSIONS The multidrug-resistant bacterial isolates account for 82.4% of the UTIs. Therefore, antibiotic prescription should follow the antimicrobial stewardship guidelines. Behavioral education significantly reduced the incidence of recurrent UTI.
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Affiliation(s)
- Hany M El Hennawy
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia.
| | - Omar Safar
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Abdullah S Al Faifi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Abdelaziz A Abdelaziz
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ali A Al Shehri
- Adult Infectious Disease Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Eisa Al Atta
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Mohammed Korkoman
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ahmed Mahedy
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ahmed I Kamal
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Naveed Mirza
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Meshary Al Shahrani
- Surgery Department, Section of Transplantation, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Mohammad F Zaitoun
- Pharmacy Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Adel Elatreisy
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia; Urology Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Osama Shalkamy
- Urology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia; Urology Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
| | - Khalid Al Sheikh
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Ali Al Fageeh
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
| | - Weam El Nazer
- Nephrology Department, Armed Forces Hospitals Southern Region, Khamis Mushayte, Saudi Arabia
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Carugati M, Arif S, Sudan DL, Collins BH, Haney JC, Schroder JN, Reynolds JM, Lewis SS, Yarrington ME, Miller RA, Alexander BD. Epidemiology of surgical site infections after solid organ transplants in the period 2015-2019: A single-center retrospective cohort study. Am J Transplant 2022; 22:3021-3030. [PMID: 36056456 DOI: 10.1111/ajt.17189] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 08/25/2022] [Accepted: 08/30/2022] [Indexed: 01/25/2023]
Abstract
Surgical site infections (SSI) are severe complications of solid organ transplant (SOT). This retrospective study assessed the epidemiology of and outcomes associated with invasive primary SSI (IP-SSI) occurring within 3 months of transplantation in adult SOT recipients at Duke University over a 5-year period (2015-2019). Among 2073 consecutive SOT recipients, 198 IP-SSI were identified. The IP-SSI rate declined over the period (14.4% in 2015 vs. 8.3% in 2019) and was higher among multi-organ compared with single-organ transplants (33.9% vs. 8.1%, p < .01). SOT recipients with IP-SSI had longer hospital stays than patients without SSI (30.0 vs. 17.0 days, p < .01). Transplant hospitalization (9.6% vs. 2.2%, p < .01), 6-month (11.6% vs. 3.3%, p < .01), and 1-year mortality (15.7% vs. 5.8%, p < .01) were higher in SOT recipients with IP-SSI than in those without. While Gram-positive bacteria were the most common pathogens, urogenital Mollicute and atypical Mycobacteria were identified as an unexpected cause of IP-SSI, particularly among lung transplant recipients. The median time to IP-SSI was 24.0 (IQR 13.8-48.3) days, although the time to IP-SSI varied based on organ transplanted and the causative pathogen. IP-SSI is an important and potentially modifiable complication of SOT, associated with prolonged hospitalizations and reduced survival, particularly in the lung transplant population.
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Affiliation(s)
- Manuela Carugati
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Sana Arif
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Debra Lynn Sudan
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - Bradley Henry Collins
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - John Carroll Haney
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina, USA
| | - Jacob Niall Schroder
- Department of Surgery, Division of Cardiovascular and Thoracic Surgery, Duke University, Durham, North Carolina, USA
| | - John Michael Reynolds
- Department of Medicine, Transplant Pulmonology, Duke University, Durham, North Carolina, USA
| | - Sarah Stamps Lewis
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | | | - Rachel Ann Miller
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - Barbara Dudley Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
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7
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Mowrer C, Lyden E, Matthews S, Abbas A, Bergman S, Alexander BT, Van Schooneveld TC, Stohs EJ. Beta-lactam allergies, surgical site infections, and prophylaxis in solid organ transplant recipients at a single center: A retrospective cohort study. Transpl Infect Dis 2022; 24:e13907. [PMID: 36254522 PMCID: PMC9787036 DOI: 10.1111/tid.13907] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Beta-lactam allergies (BLAs) are common in hospitalized patients, including transplant recipients. BLA is associated with decreased use of preferred surgical site infection (SSI) prophylaxis and increased SSIs, but this has not been studied in the transplant population. METHODS We reviewed adult heart, kidney, and liver transplant recipients between January 1, 2016 and December 31, 2019 to characterize reported BLA and collect SSI prophylaxis regimens at time of transplant. We compared the use of preferred SSI prophylaxis and SSI incidence based on reported BLA status. Post hoc we collected antibiotic days of therapy (DOT) (excluding pneumocystis prophylaxis) in the 30-day period posttransplant for patients without SSI. We utilized descriptive statistics for comparisons. RESULTS Of 691 patients included (116 heart, 400 kidney, and 175 liver transplant recipients), 118 (17%) reported BLA. Rash and hives were the two most reported BLA reactions (36% and 24%), categorized as potential T-cell mediated and IgE mediated, respectively. Preferred SSI prophylaxis was prescribed in 13 (11%) patients with BLA and 573 (92%) without BLA (p < .001). No difference could be detected in SSI incidence between BLA and non-BLA patients (4.2 vs. 4.3%, p = 1.0). Of 659 without SSI, 169 (25.6%) received antibiotics within 30 days of transplant; mean antibiotic DOT for BLA and non-BLA patients were 3.5 ± 8.0 versus 2.3 ± 5.8, p = .12. CONCLUSION BLA transplant recipients received nonpreferred SSI prophylaxis more frequently than non-BLA recipients, but there was no difference in 30-day SSIs between the groups. One-fourth of solid organ transplant recipients received systemic antibiotics within 30 days of transplant.
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Affiliation(s)
- Clayton Mowrer
- Division of Infectious DiseasesDepartment of MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Elizabeth Lyden
- Department of BiostatisticsCollege of Public HealthUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Stephen Matthews
- Infection Control and EpidemiologyNebraska MedicineOmahaNebraskaUSA
| | - Anum Abbas
- Division of Infectious DiseasesDepartment of MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Scott Bergman
- Department of Pharmaceutical and Nutritional CareNebraska MedicineOmahaNebraskaUSA
| | - Bryan T. Alexander
- Department of Pharmaceutical and Nutritional CareNebraska MedicineOmahaNebraskaUSA
| | - Trevor C. Van Schooneveld
- Division of Infectious DiseasesDepartment of MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
| | - Erica J. Stohs
- Division of Infectious DiseasesDepartment of MedicineUniversity of Nebraska Medical CenterOmahaNebraskaUSA
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8
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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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9
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Suárez Fernández ML, Ridao Cano N, Álvarez Santamarta L, Gago Fraile M, Blake O, Díaz Corte C. A Current Review of the Etiology, Clinical Features, and Diagnosis of Urinary Tract Infection in Renal Transplant Patients. Diagnostics (Basel) 2021; 11:1456. [PMID: 34441390 PMCID: PMC8392421 DOI: 10.3390/diagnostics11081456] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/26/2021] [Accepted: 08/05/2021] [Indexed: 12/23/2022] Open
Abstract
Urinary tract infection (UTI) represents the most common infection after kidney transplantation and remains a major cause of morbidity and mortality in kidney transplant (KT) recipients, with a potential impact on graft survival. UTIs after KT are usually caused by Gram-negative microorganisms. Other pathogens which are uncommon in the general population should be considered in KT patients, especially BK virus since an early diagnosis is necessary to improve the prognosis. UTIs following kidney transplantation are classified into acute simple cystitis, acute pyelonephritis/complicated UTI, and recurrent UTI, due to their different clinical presentation, prognosis, and management. Asymptomatic bacteriuria (ASB) represents a frequent finding after kidney transplantation, but ASB is considered to be a separate entity apart from UTI since it is not necessarily a disease state. In fact, current guidelines do not recommend routine screening and treatment of ASB in KT patients, since a beneficial effect has not been shown. Harmful effects such as the development of multidrug-resistant (MDR) bacteria and a higher incidence of Clostridium difficile diarrhea have been associated with the antibiotic treatment of ASB.
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Affiliation(s)
- María Luisa Suárez Fernández
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | - Natalia Ridao Cano
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | - Lucia Álvarez Santamarta
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | - María Gago Fraile
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
| | | | - Carmen Díaz Corte
- Unidad de Gestión Clínica de Nefrología, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (N.R.C.); (L.Á.S.); (M.G.F.); (C.D.C.)
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10
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Yesiler FI, Yazar Ç, Sahintürk H, Zeyneloglu P, Haberal M. Posttransplant Pneumonia Among Solid Organ Transplant Recipients Followed in Intensive Care Unit. EXP CLIN TRANSPLANT 2021; 20:83-90. [PMID: 34269656 DOI: 10.6002/ect.2021.0215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Pneumonia is a significant cause of morbidity and mortality in solid-organ transplant recipients. We studied the demographic characteristics, respiratory management, and outcomes of solid-organ transplant recipients with pneumonia in an intensive care unit. MATERIALS AND METHODS There have been 2857 kidney, 687 liver, and 142 heart transplants performed between October 16, 1985, and February 28, 2021, at our center. We retrospectively analyzed records for 51 of 193 recipients with pneumonia during the posttransplant period between January 1, 2016, and December 31, 2018. RESULTS Fifty-one of 193 recipients were followed in the intensive care unit. Mean age was 45.4 ± 16.6 years among 42 male (82.4%) and 9 female (17.6%) recipients. Twenty-six patients (51%) underwent kidney transplant, 14 (27.5%) liver transplant, 7 (13.7%) heart transplant, and 4 (7.8%) combined kidney and liver transplant. Most pneumonia episodes occurred 6 months after transplant (70.6%) with acute hypoxemic respiratory failure. Mean Acute Physiology and Chronic Health Evaluation System II score was 18.9 ± 7.7, and the Sequential Organ Failure Assessment score was 8.5 ± 3.9 at intensive care unit admission. Whereas 66.7% of pneumonia cases were nosocomial acquired, 33.3% were community acquired. The intensive care unit and 28-day mortality rates were 39.2% and 64.7%, respectively. CONCLUSIONS Solid-organ transplant recipients with pneumonia have been associated with poor prognosis. Our cohort followed in the intensive care unit comprised mostly patients with nosocomial pneumonia with acute hypoxemic respiratory failure, hospitalized 6 months after transplant with high Acute Physiology and Chronic Health Evaluation System II scores predictive of mortality. In this high-risk patient group, careful follow-up, early discovery of warning signs, and rapid treatment initiation could improve the outcomes in the intensive care unit.
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Affiliation(s)
- Fatma Irem Yesiler
- From the Department of Anesthesiology and Critical Care Unit, Baskent University Faculty of Medicine, Ankara, Turkey
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11
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Velioglu A, Guneri G, Arikan H, Asicioglu E, Tigen ET, Tanidir Y, Tinay İ, Yegen C, Tuglular S. Incidence and risk factors for urinary tract infections in the first year after renal transplantation. PLoS One 2021; 16:e0251036. [PMID: 33939755 PMCID: PMC8092797 DOI: 10.1371/journal.pone.0251036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/17/2021] [Indexed: 11/19/2022] Open
Abstract
Background The most common infections among renal transplant patients are urinary tract infections (UTI). Our main objective in this study is to determine the incidence of UTIs in patients who have undergone renal transplantation in our hospital, to identify the causative microbiological agents, risk factors and determine the effects of UTI on short-term graft survival. Methods Urinary tract infections, which developed within the first year of renal transplantation, were investigated. Patients were compared regarding demographic, clinical, laboratory characteristics and graft survival. Results 102 patients were included in our study. Fifty-three patients (53%) were male and 49 (48%) were female. Sixty-seven urinary tract infection attacks in 21 patients (20.5%) were recorded. Age (p = 0.004; 95% Confidence Interval [CI]: 1.032–1.184), longer indwelling urinary catheter stay time (p = 0.039; 95% Confidence Interval [CI]: 1.013–1.661) and urologic complications (p = 0.006; 95% Confidence Interval [CI]: 0.001–0.320) were found as risk factors for UTI development in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated microorganisms. Of these bacteria, 63.2% were found to be extended spectrum beta lactamase (ESBL) positive. Multidrug resistant microorganisms (MDROs) were more frequent in male patients (32 episodes in males vs. 14 episodes in females, p = <0.001). UTI had no negative impact on short-term graft survival. Conclusion Our study results represent the high incidence of UTI with MDROs in KT recipients. Infection control methods should be applied even more vigorously especially in male transplant patients since a higher incidence of UTI caused by resistant microorganisms was reported in male patients.
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Affiliation(s)
- Arzu Velioglu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
- * E-mail:
| | - Gokhan Guneri
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Hakki Arikan
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Ebru Asicioglu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Elif Tukenmez Tigen
- Department of Infectious Disease, Marmara University School of Medicine, Istanbul, Turkey
| | - Yiloren Tanidir
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - İlker Tinay
- Department of Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Cumhur Yegen
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
| | - Serhan Tuglular
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
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12
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Hreńczuk M, Biedrzycka A, Łągiewska B, Kosieradzki M, Małkowski P. Surgical Site Infections in Liver Transplant Patients: A Single-Center Experience. Transplant Proc 2020; 52:2497-2502. [PMID: 32362463 DOI: 10.1016/j.transproceed.2020.02.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/08/2020] [Accepted: 02/13/2020] [Indexed: 02/07/2023]
Abstract
AIM The aim of the study was a single-center assessment of occurrence of surgical site infections (SSI) in patients after liver transplantation and an attempt to determine factors that may contribute to this complication. PATIENTS AND METHODS Analysis of medical records of 60 adult patients, who underwent first transplantation in 2016 and 2017 was conducted. Selected pre-, intra-, and postoperative factors were assessed. Statistical analysis was performed with StatSoft Statistica 13.1 PL package. RESULTS SSI occurred in 25% of liver recipients, with average timing of diagnosis on the 14th day after surgery. Mean duration of hospitalization was significantly longer in patients who experienced SSI than in patients without this complication (35.8 ± 8.9 days vs 25.2 ± 6 days, P < .0001). SSI occurred a little more frequently in men and older recipients, as well as in overweight and underweight patients (not significant). An indication for transplantation did not have an impact on SSI occurrence. The complication was more likely in patients with diabetes and renal failure prior to transplantation (P > .05). Duration of the procedure, blood loss and prolonged drainage did not have any impact on SSIs. SSI was significantly more common in recipients with lower total protein value (P < .0002) and anemia (P < .0002) in early postoperative period. CONCLUSION Among the studied population, a high incidence of SSI was noted, and that some of the identified risk factors differ from those described in the literature.
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Affiliation(s)
- Marta Hreńczuk
- Department of Surgical and Transplantation Nursing, and Extracorporeal Treatment, Faculty of Health Sciences, Medical University of Warsaw, Poland.
| | - Anna Biedrzycka
- Faculty of Health Sciences, Medical University of Warsaw, Poland
| | - Beata Łągiewska
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
| | - Maciej Kosieradzki
- Department of General and Transplantation Surgery, Medical University of Warsaw, Poland
| | - Piotr Małkowski
- Department of Surgical and Transplantation Nursing, and Extracorporeal Treatment, Faculty of Health Sciences, Medical University of Warsaw, Poland
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13
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Pham C, Kuten SA, Knight RJ, Nguyen DT, Graviss EA, Gaber AO. Assessment of infectious complications in elderly kidney transplant recipients receiving induction with anti-thymocyte globulin vs basiliximab. Transpl Infect Dis 2020; 22:e13257. [PMID: 32031729 DOI: 10.1111/tid.13257] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/27/2019] [Accepted: 01/26/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Elderly transplant recipients experience lower rates of acute rejection with higher rates of infectious complications compared to their younger counterparts. While less intensive immunosuppression may be preferable, there are no recommendations for depleting versus non-depleting induction strategies. We sought to compare infectious complications between anti-thymocyte globulin (ATG) and basiliximab (IL2RA) induction in elderly kidney transplant recipients (KTRs). METHODS We reviewed 146 KTRs ≥65 years receiving ATG or IL2RA induction. Per institution protocol, ATG was administered to patients with the following characteristics, irrespective of age: African American (AA), PRA ≥20%, and/or re-transplantation. Infectious complications (bacterial, viral, and invasive fungal) at 1 year were compared. RESULTS There were significantly more AA, deceased donors, and sensitized KTRs in the ATG group, reflecting criteria for induction agent. ATG KTRs experienced higher rates of overall infectious complications (77% vs 56%, P = .01), driven by increased bacterial (54% vs 39%, P = .08) and viral infections (51% vs 35%, P = .05). Urinary tract infections (UTIs) and CMV in particular occurred at high rates among ATG patients (46% and 32%, respectively). In multivariate analysis, the only independent risk factor associated with increased risk for infection was induction with ATG (adjusted HR 1.71 [95% CI 1.04-2.83], P = .04). Overall rates of immunologic outcomes were low. CONCLUSION Elderly KTRs receiving ATG are at an increased risk for infectious complications, largely attributed to high rates of UTIs and CMV. Additional strategies aimed at mitigating these complications in elderly patients requiring ATG may be beneficial.
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Affiliation(s)
- Christine Pham
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
| | - Samantha A Kuten
- Department of Pharmacy, Houston Methodist Hospital, Houston, Texas
| | - Richard J Knight
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - Edward A Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, Texas.,Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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14
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Yu X, Chen M, Liu X, Chen Y, Hao Z, Zhang H, Wang W. Risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease. BMC Infect Dis 2020; 20:64. [PMID: 31964345 PMCID: PMC6975050 DOI: 10.1186/s12879-020-4769-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/07/2020] [Indexed: 01/22/2023] Open
Abstract
Background The aim of our study was to analyze the risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease (CHD). Methods We performed a retrospective cohort study, and children with CHD who underwent open-heart surgeries at Shanghai Children’s Medical Center from January 1, 2012 to December 31, 2018 were included. The baseline characteristics of these patients of different ages, including neonates (0–1 months old), infants (1–12 months old) and children (1–10 years old), were analyzed, and the association of risk factors with postoperative nosocomial infection were assessed. Results A total of 11,651 subjects were included in the study. The overall nosocomial infection rate was 10.8%. Nosocomial infection rates in neonates, infants, and children with congenital heart disease were 32.9, 15.4, and 5.2%, respectively. Multivariate logistic regression analysis found age (OR 0798, 95%CI: 0.769–0.829; P < 0.001), STS risk grade (OR 1.267, 95%CI: 1.159–1.385; P < 0.001), body mass index (BMI) <5th percentile (OR 1.295, 95%CI: 1.023–1.639; P = 0.032), BMI >95th percentile (OR 0.792, 95%CI: 0.647–0.969; P = 0.023), cardiopulmonary bypass (CPB) time (OR 1.008, 95%CI: 1.003–1.012; P < 0.001) and aortic clamping time (OR 1.009, 1.002–1.015; P = 0.008) were significantly associated with nosocomial infection in CHD infants. After adjusted for confounding factors, we found STS risk grade (OR 1.38, 95%CI: 1.167–1.633; P < 0.001), BMI < 5th percentile (OR 1.934, 95%CI: 1.377–2.715; P < 0.001), CPB time (OR 1.018, 95%CI: 1.015–1.022; P < 0.001), lymphocyte/WBC ratio<cut off value (OR 3.818, 95%CI: 1.529–9.533; P = 0.004) and AST>cut off value (OR 1.546, 95%CI: 1.119–2.136; P = 0.008) were significantly associated with nosocomial infection in CHD children. Conclusion Our study suggested STS risk grade, BMI, CPB duration, low lymphocyte/WBC or high neutrophil/WBC ratio were independently associated with nosocomial infection in CHD infant and children after cardiac surgery.
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Affiliation(s)
- Xindi Yu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Maolin Chen
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Xu Liu
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China
| | - Yiwei Chen
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Zedong Hao
- Shanghai Synyi Medical Technology Co., Ltd, Shanghai, China
| | - Haibo Zhang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China.
| | - Wei Wang
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong district, Shanghai, China.
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15
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Abbo LM, Grossi PA. Surgical site infections: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13589. [PMID: 31077619 DOI: 10.1111/ctr.13589] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
These guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of post-operative surgical site infections (SSIs) in solid organ transplantation. SSIs are a significant cause of morbidity and mortality in SOT recipients. Depending on the organ transplanted, SSIs occur in 3%-53% of patients, with the highest rates observed in small bowel/multivisceral, liver, and pancreas transplant recipients. These infections are classified by increasing invasiveness as superficial incisional, deep incisional, or organ/space SSIs. The spectrum of organisms implicated in SSIs in SOT recipients is more diverse than the general population due to other important factors such as the underlying end-stage organ failure, immunosuppression, prolonged hospitalizations, organ transportation/preservation, and previous exposures to antibiotics in donors and recipients that could predispose to infections with multidrug-resistant organisms. In this guideline, we describe the epidemiology, clinical presentation, differential diagnosis, potential pathogens, and management. We also provide recommendations for the selection, dosing, and duration of peri-operative antibiotic prophylaxis to minimize post-operative SSIs.
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Affiliation(s)
- Lilian M Abbo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Paolo Antonio Grossi
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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16
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Gudiol C, Sabé N, Carratalà J. Is hospital-acquired pneumonia different in transplant recipients? Clin Microbiol Infect 2019; 25:1186-1194. [PMID: 30986554 DOI: 10.1016/j.cmi.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/29/2019] [Accepted: 04/03/2019] [Indexed: 12/25/2022]
Abstract
Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are serious complications in transplant patients. The aim of this review is to summarize the evidence regarding nosocomial pneumonia in transplant recipients, including HAP in non-ventilated patients and VAP, and to identify future directions for improvement.A comprehensive literature search in the PubMed/MEDLINE database was performed. Articles written in English and published between 1990 and November 2018 were included. HAP/VAP in transplant patients usually occurs early post-transplant, particularly during neutropenia in haematopoietic stem cell transplant recipients. Bacteria are the leading cause of nosocomial pneumonia for both immunocompetent and transplant recipients, being Gram negative organisms, and especially Pseudomonas aeruginosa, highly prevalent. Multidrug-resistant bacteria are of special concern. Pneumonia in the transplant setting may be caused by opportunistic pathogens, and the differential diagnosis needs to be extended to other non-infectious complications. The most relevant opportunistic pathogens are Aspergillus fumigatus, Pneumocystis jirovecii and cytomegalovirus. Nevertheless, they are an exceptional cause of nosocomial pneumonia, and usually occur in severely immunosuppressed patients not receiving antimicrobial prophylaxis. Performing bronchoalveolar lavage may improve the rate of aetiological diagnosis, leading to a change in therapeutic management and improved outcomes. The optimal length of antibiotic therapy for bacterial HAP/VAP has not been well defined, but it should perhaps be longer than in the general population. Mortality associated with HAP/VAP is high. HAP/VAP in transplant patients is frequent and is associated with increased mortality. There is room for improvement in gaining knowledge about the management of HAP/VAP in this population.
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Affiliation(s)
- C Gudiol
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - N Sabé
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain
| | - J Carratalà
- Infectious Diseases Department, Bellvitge University Hospital, IDIBELL, University of Barcelona, Spain; REIPI (Spanish Network for Research in Infectious Disease), Instituto de Salud Carlos III, Madrid, Spain.
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17
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Ness D, Olsburgh J. UTI in kidney transplant. World J Urol 2019; 38:81-88. [DOI: 10.1007/s00345-019-02742-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/26/2019] [Indexed: 12/27/2022] Open
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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: 96] [Impact Index Per Article: 19.2] [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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19
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Pesce F, Martino M, Fiorentino M, Rollo T, Simone S, Gallo P, Stallone G, Grandaliano G, Schena A, Margiotta M, Mininni D, Palieri R, Lucarelli G, Battaglia M, Gesualdo L, Castellano G. Recurrent urinary tract infections in kidney transplant recipients during the first-year influence long-term graft function: a single-center retrospective cohort study. J Nephrol 2019; 32:661-668. [PMID: 30701457 DOI: 10.1007/s40620-019-00591-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/22/2019] [Indexed: 02/06/2023]
Abstract
Urinary tract infections (UTIs) after kidney transplantation are associated with significant morbidity. However, data on the impact of UTI on graft survival are controversial. We conducted a retrospective cohort study of 380 kidney transplant patients. Recipients with symptomatic UTIs during the first year after transplantation were categorized into three groups: early (< 3 episodes from months 1st to 6th), late (< 3 episodes during months 7th to 12th) and recurrent (≥ 3 episodes throughout the whole first year). Graft function at three years was considered the primary outcome. Symptomatic UTIs occurred in 184 (48.4%) kidney transplant recipients during the first year; 83 (21.8%) patients developed early UTIs, 50 (13.2%) late UTIs and 51 (13.4%) recurrent UTIs. We observed a significant improvement in graft function after three years in all patients (P < 0.001) except those who had recurrent UTIs. A Kaplan-Meier analysis showed that recipients with recurrent UTIs had worse graft outcome (eGFR value < 60 mL/min/1.73 m2) (P = 0.01). Recurrent UTIs was an independent predictor of graft function at three years in a model adjusted for DGF and episodes of acute rejection (Hazard Ratio, 2.2; 95% CI, 1.3 to 3.5; P = 0.001). Recurrent symptomatic UTIs during the first year after transplantation have negative impact on long-term graft function.
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Affiliation(s)
- Francesco Pesce
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Marida Martino
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Marco Fiorentino
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy.,Department of Critical Care Medicine, Center for Critical Care Nephrology, CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Center, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Tiziana Rollo
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Simona Simone
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Pasquale Gallo
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Giovanni Stallone
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giuseppe Grandaliano
- Nephrology Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Schena
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Marcella Margiotta
- Tissue Typing and Immunology of Transplants Unit, Department of Diagnostic Pathology, University of Bari, Bari, Italy
| | - Donata Mininni
- Tissue Typing and Immunology of Transplants Unit, Department of Diagnostic Pathology, University of Bari, Bari, Italy
| | - Rita Palieri
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Giuseppe Lucarelli
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Michele Battaglia
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy
| | - Giuseppe Castellano
- Department of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplantation Unit, University of Bari, Bari, Italy. .,Center for Diagnosis and Treatment of Hereditary Angioedema, Piazza G. Cesare 11, 70124, Bari, Italy.
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Updates on urinary tract infections in kidney transplantation. J Nephrol 2019; 32:751-761. [PMID: 30689126 DOI: 10.1007/s40620-019-00585-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/09/2019] [Indexed: 01/20/2023]
Abstract
Urinary tract infection (UTI) represents the most common infection after kidney transplantation; it is associated with an increased risk for acute kidney rejection and impaired graft function in the early post-transplant period. Kidney transplant recipients with UTIs are often clinically asymptomatic due to the immunosuppressive therapy; however, asymptomatic bacteriuria may progress to acute pyelonephritis, bacteremia and urosepsis, particularly in the early post-transplant period, that are independent risk factors for short and long-term graft and patient survival. This article reviews the definitions, incidence, risk factors and the management of UTI in kidney transplant recipients; furthermore, the main controversial and still unanswered questions, regarding the causes of recurrent UTIs, adequate use of antibiotics to avoid antibiotic resistance, dosing and timing for prophylaxis and treatment of symptomatic infections, are also discussed. The emerging definition of urinary microbiota introduces new concepts in understanding the complexity of the disease and might represent the future target for therapeutic interventions.
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Menezes FG, Corrêa L, Medina-Pestana JO, Aguiar WF, Camargo LFA. A randomized clinical trial comparing Nitrofurazone-coated and uncoated urinary catheters in kidney transplant recipients: Results from a pilot study. Transpl Infect Dis 2018; 21:e13031. [PMID: 30451342 DOI: 10.1111/tid.13031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Urinary tract infections are frequent complications early after kidney transplantation, and the use of antimicrobial coated catheters in settings other than transplantation has shown promising results for infection prevention. The purpose of this study was to compare the efficacy of Nitrofurazone-coated silicone urinary catheters with non-impregnated silicone urinary catheters in reducing bacteriuria and urinary tract infections in kidney transplant recipients. METHODS This single-center study, randomized controlled trial at the Hospital do Rim, a tertiary referral center in kidney transplantation, located in São Paulo, Brazil. Subjects involved living donor kidney transplant recipients, and were randomized 1:1 ratio with a computer-generated system to a Nitrofurazone-coated silicone urinary catheter and non-impregnated silicone urinary catheter from March 2013 to December 2014. Patients with asymptomatic bacteriuria or urinary tract infection at baseline, deceased kidney transplant donors, patients with known hypersensitivity to nitrofurantoin, pregnancy, and those refusing to sign the informed consent form were excluded from the study. RESULTS Two hundred fourteen subjects were randomized and one hundred seventy-six completed the study. There were no differences in the rates of asymptomatic bacteriuria (12.5% in the Nitrofurazone group and 11.4% in the control group, P = 0.99) and urinary tract infection (8% and 6.8%, P = 0.99) and the incidence of side effects was more frequent in the Nitrofurazone-impregnated silicone urinary catheter group (46.6% and 26.1%, P = 0.007). CONCLUSION The study suggests that there is no beneficial effect of the employment of Nitrofurazone-coated urinary catheter. TRIAL REGISTRATION NUMBER ISRCTN57888785.
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Affiliation(s)
- Fernando Gatti Menezes
- Infection Control and Prevention Service, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Luci Corrêa
- Infectious Diseases Division, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Luis Fernando Aranha Camargo
- Infectious Diseases Division, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo, Brazil
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Bodro M, Linares L, Chiang D, Moreno A, Cervera C. Managing recurrent urinary tract infections in kidney transplant patients. Expert Rev Anti Infect Ther 2018; 16:723-732. [PMID: 30092153 DOI: 10.1080/14787210.2018.1509708] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Recurrent urinary tract infections (UTI) are a common clinical problem in kidney transplant recipients. Due to the complex urological anatomy derived from the implantation of the kidney graft, the spectrum of the disease and the broad underlying pathophysiological mechanisms. Recurrent UTI worsen the quality of life, decrease the graft survival and increase the costs of kidney transplantation. Areas covered: In this review, we describe the definitions, clinical characteristics, pathophysiological mechanisms and microbiology of recurrent urinary tract infections in kidney transplantations. The actual published literature on the management of recurrent urinary tract infections is based on case series, observational cohorts and very few clinical trials. In this review, the available evidence is compiled to propose evidence-based strategies to manage these complex cases. Expert commentary: The management of recurrent urinary tract infections in kidney transplant patients requires a proper diagnosis of the underlying mechanism. Early identification of structural or functional urological abnormalities, potentially amenable for surgical correction, is crucial for a successful management. The use of antibiotics to prevent recurrent infections should be carefully evaluated to avoid side effects and emergence of antibiotic-resistant microorganisms.
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Affiliation(s)
- Marta Bodro
- a Division of Infectious Diseases , Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona , Barcelona , Spain
| | - Laura Linares
- a Division of Infectious Diseases , Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona , Barcelona , Spain
| | - Diana Chiang
- b Department of Medicine , University of Alberta , Edmonton , Canada
| | - Asuncion Moreno
- a Division of Infectious Diseases , Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona , Barcelona , Spain
| | - Carlos Cervera
- b Department of Medicine , University of Alberta , Edmonton , Canada
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Britt NS, Hagopian JC, Brennan DC, Pottebaum AA, Santos CAQ, Gharabagi A, Horwedel TA. Effects of recurrent urinary tract infections on graft and patient outcomes after kidney transplantation. Nephrol Dial Transplant 2018; 32:1758-1766. [PMID: 28967964 DOI: 10.1093/ndt/gfx237] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 06/13/2017] [Indexed: 11/14/2022] Open
Abstract
Background Urinary tract infections (UTIs) are common following kidney transplantation (KT); however, the influence of recurrent post-KT UTI (R-UTI) is not well-characterized. Methods We compared graft outcomes, patient outcomes and multidrug-resistance rates between patients with no UTI, nonrecurrent UTI (NR-UTI) (urine sample containing >105 bacterial colony-forming units/mL) and R-UTI (≥2 UTIs in any 6-month period or ≥3 UTIs in any 12-month period) post-KT in a retrospective cohort study (1999-2014) at Barnes-Jewish Hospital (St Louis, MO). All adult KT recipients were included and those experiencing mortality within 30 days of KT were excluded. Results Of 2469 recipients included, 1835 (74.3%) had no UTI, 465 (18.8%) had NR-UTI and 169 (6.8%) had R-UTI. R-UTI was associated with poorer graft survival compared with NR-UTI [hazard ratio (HR) 1.45; 95% confidence interval (CI) 1.23-1.83; P < 0.001) and no UTI (HR 2.11; 95% CI 2.02-3.80; P < 0.001). This relationship persisted after adjusting for confounding factors in Cox regression (HR 2.01; 95% CI 1.53-2.66; P < 0.001). There was no difference in patient survival between no UTI and NR-UTI (HR 1.21; 95% CI 0.91-1.63; P = 0.181); however, R-UTI was associated with poorer patient survival compared with nonrecurrent cases (HR 1.87; 95% CI 1.21-2.89; P = 0.005). R-UTI were more likely to be caused by multidrug-resistant Gram-negative organisms (risk ratio 1.49; 95% CI 1.31-1.70; P < 0.001). Conclusions R-UTIs were associated with poorer graft and patient outcomes, as well as increased multidrug-resistance compared with nonrecurrent cases.
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Affiliation(s)
- Nicholas S Britt
- Department of Pharmacy, Barnes-Jewish Hospital, St Louis, MO, USA
| | - Jennifer C Hagopian
- Department of Pharmacy, Barnes-Jewish Hospital, St Louis, MO, USA.,Department of Medicine, Division of Nephrology, Washington University School of Medicine, St Louis, MO, USA
| | - Daniel C Brennan
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St Louis, MO, USA
| | | | - Carlos A Q Santos
- Department of Internal Medicine, Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - Ara Gharabagi
- Department of Medicine, Division of Nephrology, Washington University School of Medicine, St Louis, MO, USA
| | - Timothy A Horwedel
- Department of Pharmacy, Barnes-Jewish Hospital, St Louis, MO, USA.,Department of Medicine, Division of Nephrology, Washington University School of Medicine, St Louis, MO, USA
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24
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Camargo LF, Lother AM, Mazzali M, Stucchi RSB. Immunization in end stage renal disease: The perception of waiting list patients. Transpl Infect Dis 2018; 20:e12831. [PMID: 29337400 DOI: 10.1111/tid.12831] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 11/08/2017] [Accepted: 12/15/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND The number of patients with chronic kidney disease is increasing worldwide, as well as the number of patients in kidney transplant waiting lists. In order to prevent infections related to immunosuppressive therapy, immunization guidelines for CKD patients before transplantation have been proposed. The aim of the present study was to evaluate adherence to immunization in a cohort of CKD patients in transplant waiting list and their renal replacement therapy clinics. METHODS CKD patients older than 18 years old, receiving renal replacement therapy longer than 12 months and included in kidney transplant waiting list at University of Campinas (Unicamp) were enrolled. RESULTS From February 2014 to December 2015, 105 patients fulfilled the inclusion criteria. Complete hepatitis B vaccination was observed in 73% and influenza vaccine in 67%. None of the other vaccine protocols reached 50% of coverage. Patients receiving immunization at primary health units presented higher coverage for diphtheria, tetanus (dT), measles, mumps, rubella (MMR), and hepatitis B vaccines, while patients immunized at renal replacement therapy clinics showed higher prevalence of pneumococcus (pneumo23). CONCLUSION The low rates of immunization could reflect the RRT's clinics knowledge about the vaccines guidelines and its application on daily care. We suggest an integration between transplant center and RRT clinics, through lectures, periodic checking of vaccination cards, and easy to follow guidelines in order to provide a better vaccine coverage and to obtain higher immunization rates.
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Affiliation(s)
- Leonardo Figueiredo Camargo
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Renal Transplant Unit, Clinics Hospital, University of Campinas, Campinas, SP, Brazil
| | | | - Marilda Mazzali
- Division of Nephrology, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil.,Renal Transplant Unit, Clinics Hospital, University of Campinas, Campinas, SP, Brazil
| | - Raquel S B Stucchi
- Division of Infectious Diseases, Department of Internal Medicine, School of Medical Sciences, University of Campinas, Campinas, SP, Brazil
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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: 48] [Impact Index Per Article: 8.0] [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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26
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Perioperative Antibiotic Prophylaxis to Prevent Surgical Site Infections in Solid Organ Transplantation. Transplantation 2018; 102:21-34. [DOI: 10.1097/tp.0000000000001848] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
As immunosuppressive therapy has evolved over the years, rejection rates in solid organ transplant have declined, but infections remain a significant cause of morbidity and mortality in this population. Prophylaxis against bacterial, viral, and fungal infections is often used to prevent infection from common pathogens during high-risk periods. As an integral part of the multidisciplinary medical team, it is important that nurses caring for transplant recipients be familiar with methods to detect and prevent infectious diseases in this population. This article presents a review of risk factors for and prevalence of common infectious pathogens, as well as important considerations regarding prophylactic medications in solid organ transplant recipients.
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Gregg JR, Kang CL, Talbot TR, Moore D, Herrell SD, Dmochowski R, Barocas DA. Symptomatic Urinary Tract Infections in Renal Transplant Recipients after Cystoscopy for Ureteral Stent Removal. UROLOGY PRACTICE 2017; 4:405-411. [PMID: 29250578 PMCID: PMC5729756 DOI: 10.1016/j.urpr.2016.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Symptomatic urinary tract infection (UTI) is a known complication of cystoscopy with ureteral stent removal. However, little is known about the incidence and risk factors for post-cystoscopy UTI in renal transplant recipients, who likely represent a high-risk cohort. Our aim was to determine the infection rate following cystoscopy with stent removal in this population and identify opportunities for care improvement. METHODS We performed a retrospective cohort study of office cystoscopies with stent removal in renal transplant recipients performed at a single institution from April 2012 through May 2014. Strict criteria were used to determine presence of symptomatic UTI within one month of the procedure. Fisher's exact tests were completed to examine associations between patient characteristics and post-transplant outcomes with UTI. RESULTS A total of 324 patients were included. Mean age was 50.0 (SD 13.1) years, and 187 (57.7%) patients were male. Within this group,165 (52.5%) patients received a pre-procedural oral fluoroquinolone antibiotic dose prior to the procedure. Nine patients had symptomatic UTIs (2.8%), of which three infections (33.3%) were due to quinolone-resistant organisms. Female sex (P =0.04), but no other patient or post-operative characteristic was associated with symptomatic UTI, including the use of peri-procedural antibiotics. CONCLUSIONS The incidence of symptomatic UTI after cystoscopy with ureteral stent removal in renal transplant recipients is less than three percent and comparable to post-cystoscopy UTI risk in the general population. Female sex is associated with symptomatic UTI. Further investigation is needed to identify groups most at risk for UTI and other complications.
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Affiliation(s)
- Justin R. Gregg
- Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN
| | - Caroline L. Kang
- Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN
| | - Thomas R. Talbot
- Vanderbilt University Medical Center, Department of Medicine, Nashville, TN
| | - Derek Moore
- Vanderbilt University Medical Center, Department of Surgery, Nashville, TN
| | - S. Duke Herrell
- Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN
| | - Roger Dmochowski
- Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN
| | - Daniel A. Barocas
- Vanderbilt University Medical Center, Department of Urologic Surgery, Nashville, TN
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Abstract
Similarly to the general population, genitourinary tract infections are common conditions in theimmunocompromised host. They can be furthermore divided into infections of the urinary tract and genital tract infections. Transplant recipients are more likely to have infections of the urinary tract infections while persons with human immunodeficiency virus (HIV) are at higher risk for the second group of infections, especially sexually transmitted infections (STIs). Manifestations of these diseases can be associated with more complications and can be more severe. We provide an overview of manifestations, diagnosis, and management of these disorders.
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30
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The impact of septicemia occurring during hospitalization for renal transplantation procedures on outcomes in adults in United States. PLoS One 2017; 12:e0179466. [PMID: 28609479 PMCID: PMC5469480 DOI: 10.1371/journal.pone.0179466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 05/30/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Immediate success rates of renal transplantation (RT) procedures are generally very high. National estimates of the impact of post-operative complications, specifically, septicemia occurring during hospitalization for RT’s on outcomes is unclear. We sought, to examine the prevalence of septicemia in patients having renal transplantation procedures and to quantify the impact of septicemia on in-hospital mortality (IHM), length of stay (LOS), and hospital charges (HC). Materials and methods We performed a retrospective analysis of the Nationwide Inpatient Sample (NIS) for the years 2004 to 2010. All patients aged ≥18 years who underwent RT were selected. Association between occurrence of septicemia and outcomes (IHM, HC and LOS) was examined by multivariable linear and logistic regression models with adjustments for patient and hospital level confounders. Results During the study period, 113,058 patients underwent RT, and, of these, 2459 (2.2%) developed septicemia. Characteristics included mean age (50 years), gender (males, 60%) and race (whites, 54%). Majority of RT’s were performed in teaching (96%) and large institutes (85.5%). Outcomes for patients with septicemia and without septicemia, included: IHM (12.9% vs. 0.4%), discharge routinely (42.4% vs. 82.6%), mean HC ($528,980 vs. $182,165), mean LOS in days (35.2 vs 7.3), respectively, Those who developed septicemia were associated with significantly higher HC (estimate: 0.8357, 95% CI: {0.7636–0.9077}, increase of $ 247,081 from mean, p<0.0001), longer LOS (1.2116{1.1015–1.3216}, increase of 18.7 days form mean, p<0.0001) and higher IHM (Odds ratio = 31.33; {20.25–48.48}, p < 0.0001) compared to their counterparts. Increasing age (OR = 1.02 {1.01–1.02}, p<0.0001) and increase in co-morbid burden (OR = 1.57 {1.42–1.74}, p<0.0001) were associated with higher risk for developing septicemia. Conclusions Despite advances in medical/surgical care, septicemia is not an uncommon complication in patients having renal transplantation procedures and is associated with poor outcomes. Increasing age and co-morbid burden are independent predictors of occurrence of septicemia.
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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: 23] [Impact Index Per Article: 3.3] [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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Shams SF, Eidgahi ES, Lotfi Z, Khaledi A, Shakeri S, Sheikhi M, Bahrami A. Urinary tract infections in kidney transplant recipients 1 st year after transplantation. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2017; 22:20. [PMID: 28458711 PMCID: PMC5367214 DOI: 10.4103/1735-1995.200274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/16/2016] [Accepted: 11/19/2016] [Indexed: 01/06/2023]
Abstract
Background: One of the main causes of adverse complications following kidney transplantation is urinary tract infection (UTI). This study was done to define the incidence rate, clinical profiles, causative microorganisms, and UTI risk factors among kidney transplant recipients in Mashhad city. Materials and Methods: In this retrospective study, we perused medical files of 247 kidney recipients who underwent transplant surgery at Mashhad University Montaserie Hospital, during 2012–2014. All patients were followed for UTI during the 1st year after surgery. Results: 75 episodes of UTI developed by 152 pathogens in 56 (22.7%) of patients during 1-year follow-up. 26.6% of total UTIs were diagnosed within the 1st month after transplantation. The most frequently isolated uropathogens were Escherichia coli (55.3%, n = 84). The high rate of candiduria (8.5%) was observed, too. Conclusion: UTI is known as one of the hospitalization reasons in kidney transplantation recipients. Defining appropriate antibiotic prophylaxis against bacterial and fungal agents and early removal of urethral catheter are suggested to decrease posttransplantation complications.
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Affiliation(s)
- Seyyede Fatemeh Shams
- Kidney Transplantation Complication Research Center, School of Medicine, Montaserie Organ Transplantation Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Hematology and Blood Bank, Cancer Molecular Pathology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Elham Shaarbaf Eidgahi
- Kidney Transplantation Complication Research Center, School of Medicine, Montaserie Organ Transplantation Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Department in Biostatistics, Faculty of Paramedical Science, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Zahra Lotfi
- Kidney Transplantation Complication Research Center, School of Medicine, Montaserie Organ Transplantation Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azad Khaledi
- Department of Microbiology and Virology, Antimicrobial Resistance Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Shakeri
- Department of Hematology and Blood Bank, Cancer Molecular Pathology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sheikhi
- Department of Hematology and Blood Bank, Cancer Molecular Pathology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Afsane Bahrami
- Kidney Transplantation Complication Research Center, School of Medicine, Montaserie Organ Transplantation Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.,Student Research Committee, Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Akbari R, Rahmani Firouzi S, Akbarzadeh-Pasha A. Old habits die hard; does early urinary catheter removal affect kidney size, bacteriuria and UTI after renal transplantation? J Renal Inj Prev 2016; 6:43-48. [PMID: 28487871 PMCID: PMC5414518 DOI: 10.15171/jrip.2017.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/04/2016] [Indexed: 11/09/2022] Open
Abstract
Introduction: Renal transplantation is the treatment of choice in chronic renal failure patients. Objectives: The purpose of this study was to evaluate the impact of urinary catheter removal time on transplanted kidney size and incidence of asymptomatic bacteriuria and urinary tract infections (UTIs). Patients and Methods: This retrospective cohort study evaluated the clinical outcomes of 109 consecutive live donor renal transplant recipients from December 2011 to July 2014. Routine ultrasound examinations were performed on donor's kidney prior to operation and one month later. Kidney volume was calculated. UTI and bacteriuria were evaluated one month later. Patients were divided into two groups based on time of Foley catheter removal (before and after fifth day posttransplantation). Results: In this study 74 males (67.9%) and 35 females (32.1%) were evaluated. Sixty-six patients (57.92%) were in group 1. None of the patients with positive urine culture had UTI but bacteriuria occurred in all of them (21.1%). Bacteriuria time after transplantation and catheter removal was significantly later in group 1 and it was not different in female group but they were later in male group. The mean renal volume increase was positively correlated to renal transplant recipient and donor's age and donor's body mass index (BMI) (P<0.05). Conclusion: This study showed that the time of catheter removal after kidney transplantation does not affect incidence of UTI but increases the probability of bacteria in men whose catheter was removed within 5 days after transplantation. We also found that the renal volume change is not associated with catheter removal time and bacteriuria.
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Affiliation(s)
- Roghayeh Akbari
- Clinical Research Development Unit, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
| | | | - Abazar Akbarzadeh-Pasha
- Clinical Research Development Unit, Ayatollah Rohani Hospital, Babol University of Medical Sciences, Babol, Iran
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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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Impact of an Infection Control and Antimicrobial Stewardship Program on Solid Organ Transplantation and Hepatobiliary Surgical Site Infections. Infect Control Hosp Epidemiol 2016; 37:1468-1474. [DOI: 10.1017/ice.2016.213] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVEThe goal of this long-term quasi-experimental retrospective study was to assess the impact of a 5-year serial infection control and antimicrobial stewardship intervention on surgical site infections (SSIs).METHODSThis study was conducted in a tertiary-care public teaching institution over a 5-year period from January 2010 to December 2014. All patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas–kidney transplantation were included. Outcomes were compared between a preintervention group (2010–2011) and a postintervention group (2012–2014).RESULTSA total of 1,424 procedures averaged an overall SSI rate of 11.2%. After implementation of the interventions, a decrease of 52.8% in SSI rates from 17.4% to 8.2% was observed (P<.001; odds ratio [OR], 2.1; 95% confidence interval [CI], 1.5–2.9). An overall significant decrease >50% (relative rate; P<.001) was observed in superficial incisional and organ-space infections between pre- and postintervention groups. In addition, a 54.9% decrease from 19.7% to 8.9% (P<.001; OR, 2.2; 95% CI, 1.4–3.5) and a 51.6% decrease from 15.5% to 7.5% (P=.001; OR, 2.2; 95% CI, 1.4–3.5) were observed for SSI rates in hepatobiliary surgery and solid organ transplantation, respectively. The antimicrobial stewardship intervention increased overall conformity to the internal surgical prophylaxis protocol by 15.2% (absolute rate) from 45.1% to 60.3% (P<.003; 95% CI, 5.4–24.9).CONCLUSIONSA long-term serial infection control and antimicrobial stewardship intervention decreased SSIs among patients undergoing hepatobiliary surgery and liver, kidney, pancreas, and simultaneous pancreas–kidney transplantation.Infect Control Hosp Epidemiol 2016;1468–1474
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Eton V, Sinyavskaya L, Langlois Y, Morin JF, Suissa S, Brassard P. Effect of Pre-Operative Use of Medications on the Risk of Surgical Site Infections in Patients Undergoing Cardiac Surgery. Surg Infect (Larchmt) 2016; 17:557-62. [DOI: 10.1089/sur.2016.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Vic Eton
- Center for Clinical Epidemiology, Department of Cardiac Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Liliya Sinyavskaya
- Center for Clinical Epidemiology, Department of Cardiac Surgery, Jewish General Hospital, Montreal, Quebec, Canada
| | - Yves Langlois
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Samy Suissa
- Center for Clinical Epidemiology, Department of Cardiac Surgery, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Paul Brassard
- Center for Clinical Epidemiology, Department of Cardiac Surgery, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
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Yabanoğlu H, Alışkan HE, Çalışkan K, Arer İ, Akdur A, Yıldırım S, Moray G, Haberal M. Early Infections in Renal Transplant Recipients: Incidence, Risk Factors, and Causative Microorganisms. EXP CLIN TRANSPLANT 2016; 13 Suppl 3:11-4. [PMID: 26640902 DOI: 10.6002/ect.tdtd2015.o9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study aimed to compare renal transplant recipients with and without infection with respect to demographic and clinical characteristics as well as risk factors; to determine the incidence of posttransplant infections; and to study the antibiotic resistance patterns of bacterial species identified as the causative organisms in posttransplant infections. MATERIALS AND METHODS This study included a total of 136 patients undergoing renal transplant in a 4-year period. The patients were categorized into 2 groups. The 2 groups were compared with each other with respect to general clinical and demographic variables and the number and frequency of infectious attacks within a 1-year follow-up, infection type, and antibiotic resistance patterns. RESULTS Ninety-two (67.6%) of the subjects were male and 44 (32.4%) were female. A total of 57 (41.9%) patients developed 128 infectious attacks. Urinary tract infections were the most common infections (42.1%). There was a significant correlation between a clinically relevant urinary culture proliferation and postoperative infection rate (P = .002). There was a significant correlation between antimicrobial resistance and the number of infectious attacks (P = .023). There was a significant correlation between the proliferation of Extended Spectrum Beta Lactamase-positive Enterobactericeae species and the number of infectious attacks (P = .000). CONCLUSIONS Presence of a clinically relevant proliferation in the preoperative urinary culture, which was identified as a risk factor for infection, increased the number of infectious attacks. Moreover, Extended Spectrum Beta Lactamase-positive Enterobactericeae species increased the number of infections. These 2 principle results should be taken into account in patient management.
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Affiliation(s)
- Hakan Yabanoğlu
- From the Department of General Surgery, Baskent University, Turkey
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Pattern of Bacterial Pathogens and Their Susceptibility Isolated from Surgical Site Infections at Selected Referral Hospitals, Addis Ababa, Ethiopia. Int J Microbiol 2016; 2016:2418902. [PMID: 27446213 PMCID: PMC4944047 DOI: 10.1155/2016/2418902] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/22/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background. The emergence of multidrug resistant bacterial pathogens in hospitals is becoming a challenge for surgeons to treat hospital acquired infections. Objective. To determine bacterial pathogens and drug susceptibility isolated from surgical site infections at St. Paul Specialized Hospital Millennium Medical College and Yekatit 12 Referral Hospital Medical College, Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted between October 2013 and March 2014 on 107 surgical site infected patients. Wound specimens were collected using sterile cotton swab and processed as per standard operative procedures in appropriate culture media; and susceptibility testing was done using Kirby-Bauer disc diffusion technique. The data were analyzed by using SPSS version 20. Result. From a total of 107 swabs collected, 90 (84.1%) were culture positive and 104 organisms were isolated. E. coli (24 (23.1%)) was the most common organism isolated followed by multidrug resistant Acinetobacter species (23 (22.1%)). More than 58 (75%) of the Gram negative isolates showed multiple antibiotic resistance (resistance ≥ 5 drugs). Pan-antibiotic resistance was noted among 8 (34.8%) Acinetobacter species and 3 (12.5%) E. coli. This calls for abstinence from antibiotic abuse. Conclusion. Gram negative bacteria were the most important isolates accounting for 76 (73.1%). Ampicillin, amoxicillin, penicillin, cephazoline, and tetracycline showed resistance while gentamicin and ciprofloxacin were relatively effective antimicrobials.
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Guler S, Cimen S, Hurton S, Molinari M. Risks and Benefits of Early Catheter Removal After Renal Transplantation. Transplant Proc 2015; 47:2855-9. [DOI: 10.1016/j.transproceed.2015.10.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 10/20/2015] [Indexed: 11/25/2022]
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40
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Kawecki D, Wszola M, Kwiatkowski A, Sawicka-Grzelak A, Durlik M, Paczek L, Mlynarczyk G, Chmura A. Bacterial and fungal infections in the early post-transplant period after kidney transplantation: etiological agents and their susceptibility. Transplant Proc 2015; 46:2733-7. [PMID: 25380905 DOI: 10.1016/j.transproceed.2014.09.115] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Infections remain serious complications in solid-organ transplant recipients, despite professional medical care, the introduction of new immunosuppressive drugs, and treatment that decreases the risk of infections. METHODS The study covered 295 adult patients undergoing kidney transplantation (KTx) between September 2001 and December 2007. All the patients were followed prospectively for infections from the KTx date and during the first 4 weeks after surgery. Samples of clinical materials were investigated for microbiological cultures. The microorganisms were cultured and identified in accordance with standard bacteriological procedures. Susceptibility testing was carried out through the use of Clinical and Laboratory Standards Institute procedures. RESULTS From 295 KTx recipients, 1073 clinical samples were taken for microbiological examination. Positive cultures were 26.9% (n = 289) of all samples tested; 525 strains were collected. Gram-positive bacteria were isolated in 52.2% (n = 274), Gram-negative bacteria were isolated in 40.8% (n = 214), and fungal strains were isolated in 7% (n = 37). Urine specimens (n = 582) were obtained from 84.5% of 245 recipients during the first month after transplantation. Among the isolated bacterial strains (n = 291), the most common were Gram-negative bacteria (56.4%). Gram-positive bacteria comprised 35.7%; fungal strains were found in 23 cases (7.9%). In surgical site specimens (n = 309), Gram-positive bacteria (72.1%) were the most common. Gram-negative bacteria comprised 24.4%. In blood specimens (n = 138), Gram-positive bacteria (81.6%) were the most common. Gram-negative bacteria comprised 15.8%; fungi were isolated in 2.6%. In respiratory tract specimens (n = 13), among the isolated bacterial strains (n = 8), the most common were Gram-positive bacteria (57.1%). Gram-negative bacteria comprised 14.3%; fungi were isolated in 28.6%. CONCLUSIONS Urine samples were predominantly positive after KTx. Our study showed Gram-positive bacteria in 52.2% after kidney transplantation. The proportion of isolates of multi-drug-resistant bacterial strains (MRCNS, vancomycin-resistant strains, high-level aminoglycoside-resistant strains, extended-spectrum beta-lactamase producers, and high-level aminoglycoside-resistant strains) was increased. These data indicate the need for strict adherence to infection control procedures in these patients.
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Affiliation(s)
- D Kawecki
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
| | - M Wszola
- Department of General Surgery and Transplantation, Medical University of Warsaw, Warsaw, Poland
| | - A Kwiatkowski
- Department of General Surgery and Transplantation, Medical University of Warsaw, Warsaw, Poland
| | - A Sawicka-Grzelak
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplant Medicine and Nephrology, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - L Paczek
- Department of Immunology, Transplantology, and Internal Diseases, Transplantation Institute, Medical University of Warsaw, Warsaw, Poland
| | - G Mlynarczyk
- Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland
| | - A Chmura
- Department of General Surgery and Transplantation, Medical University of Warsaw, Warsaw, Poland
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Capocasale E, De Vecchi E, Mazzoni MP, Dalla Valle R, Pellegrino C, Ferretti S, Sianesi M, Iaria M. Surgical site and early urinary tract infections in 1000 kidney transplants with antimicrobial perioperative prophylaxis. Transplant Proc 2015; 46:3455-8. [PMID: 25498071 DOI: 10.1016/j.transproceed.2014.07.071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 07/15/2014] [Indexed: 01/14/2023]
Abstract
Surgical site infections (SSIs) and early urinary tract infections (UTIs) are well recognized postoperative kidney transplant complications. These complications seldom lead to graft loss, although they may result in significant morbidity with prolonged hospitalization. Thus, perioperative antibiotic prophylaxis (PAP) has traditionally been used in this setting. Between April 1988 and December 2012, we identified 1000 kidney transplant recipients (33 from living donors) who underwent prophylaxis with ceftriaxone before the surgical procedure. A retrospective analysis was conducted to evaluate both the incidence rate and outcome of SSIs and UTIs. Recipients who developed SSIs were also assessed to identify risk factors and potential correlations with different immunosuppressive regimens. A total of 20 SSIs (2%) and 93 UTIs (9.3%) were observed. The most significant risk factor for SSIs was urine leak (15.38%; odds ratio [OR], 12.3; P < .0001) followed by sirolimus-based maintenance immunosuppression therapy (5%; OR, 2.97; P = .04) and induction therapy with either antithymocyte globulin or basiliximab (3.18%; OR, 3.45; P = .01). Sex was identified as the only risk factor for UTI (female vs male, 17.1% vs 4.6%; P < .0001). We believe universal ceftriaxone-based prophylaxis is useful for preventing SSIs and UTIs, considering its effectiveness and safety profile.
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Affiliation(s)
- E Capocasale
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - E De Vecchi
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - M P Mazzoni
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - R Dalla Valle
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - C Pellegrino
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - S Ferretti
- Division of Urology, Department of Surgery, Parma University Hospital, Parma, Italy
| | - M Sianesi
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy
| | - M Iaria
- Division of General Surgery and Organ Transplantation, Department of Surgery, Parma University Hospital, Parma, Italy.
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Amikacin prophylaxis and risk factors for surgical site infection after kidney transplantation. Transplantation 2015; 99:521-7. [PMID: 25254907 DOI: 10.1097/tp.0000000000000381] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. METHODS We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. RESULTS A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. CONCLUSION Amikacin prophylaxis is a useful strategy for preventing SSIs.
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Wojciuk B, Myślak M, Pabisiak K, Ciechanowski K, Giedrys-Kalemba S. Epidemiology of infections in kidney transplant recipients - data miner's approach. Transpl Int 2015; 28:729-37. [DOI: 10.1111/tri.12536] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 04/25/2014] [Accepted: 01/30/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Bartosz Wojciuk
- Department of Microbiology and Immunological Diagnostics; previously Department of Microbiology and Immunology; Pomeranian Medical University; Szczecin Poland
| | - Marek Myślak
- Clinic of Nephrology, Transplantation and Internal Medicine; Pomeranian Medical University; Szczecin Poland
| | - Krzysztof Pabisiak
- Clinic of Nephrology, Transplantation and Internal Medicine; Pomeranian Medical University; Szczecin Poland
| | - Kazimierz Ciechanowski
- Clinic of Nephrology, Transplantation and Internal Medicine; Pomeranian Medical University; Szczecin Poland
| | - Stefania Giedrys-Kalemba
- Department of Microbiology and Immunological Diagnostics; previously Department of Microbiology and Immunology; Pomeranian Medical University; Szczecin Poland
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Camargo LFA, Marra AR, Pignatari ACC, Sukiennik T, Behar PPP, Medeiros EAS, Ribeiro J, Girão E, Correa L, Guerra C, Brites C, Pereira CAP, Carneiro I, Reis M, Souza MA, Barata CU, Edmond MB. Nosocomial bloodstream infections in a nationwide study: comparison between solid organ transplant patients and the general population. Transpl Infect Dis 2015; 17:308-13. [PMID: 25726707 DOI: 10.1111/tid.12356] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 07/04/2014] [Accepted: 12/11/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The incidence of bloodstream infection (BSI) varies according to the transplanted organ. Mortality can be as high as 24%, with a significant impact on graft survival. Transplantation is a risk factor for multidrug-resistant (MDR) organisms, but comparison with a non-transplanted population in a single large cohort has not been described. METHODS This is a prospective nationwide study (16 centers) reporting data on 2364 monomicrobial nosocomial BSIs, comparing 83 episodes in solid organ transplant patients with 2447 BSIs occurring in the general hospital population. RESULTS The prevalence of groups of infecting organisms (gram-positive, gram-negative, and fungi) was similar between transplant patients and the general population and a similar crude mortality rate was observed (34.9% in transplant vs. 43.3% in non-transplant patients). Staphylococcus aureus was the single most frequently isolated organism in both groups, and Acinetobacter species was more frequently isolated in the general population. Regarding MDR organisms, Klebsiella species, and Enterobacter species resistant to cefepime, as well as Acinetobacter species resistant to meropenem, were significantly more frequent in transplant patients. CONCLUSION Antimicrobial resistance is higher, particularly among gram-negative bacteria in the transplant population, although the overall mortality rate between transplant and non-transplant patients with nosocomial BSI is similar.
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Affiliation(s)
- L F A Camargo
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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A Nationwide Assessment of the Burden of Urinary Tract Infection among Renal Transplant Recipients. J Transplant 2015; 2015:854640. [PMID: 25810918 PMCID: PMC4355558 DOI: 10.1155/2015/854640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 02/12/2015] [Accepted: 02/15/2015] [Indexed: 11/17/2022] Open
Abstract
Objective. Evaluate the prevalence and outcomes of urinary tract infection (UTI) among renal transplant recipients. Methods. A secondary analysis of the Nationwide Inpatient Sample 2009–2011 was conducted. Survey-weighted multivariable regression analyses were used to examine the impact of UTI on transplant complications, total charges, and length of stay. Results. A total of 1,044 renal transplant recipients, representing a population estimate of 49,862, were included in the study. UTI was most common in transplant recipients with hypertension (53%) and prevalence was noted to be 28.2 and 65.9 cases per 1,000 for men and women, respectively. UTI increased the likelihood of transplant complications (182% for men, 169% for women). Total charges were 28% higher among men as compared to 22% among women with UTI. Such infection also increased the length of stay by 87% among men and 74% among women. Discussion. UTI in renal transplant recipients was associated with prolonged length of stay, total charges, and increased odds of transplant complications. Interventions to prevent UTI among such patients should be a priority area for future research and practice.
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Varma PP, Jairam A, Hooda AK, Badwal S. Renal outcome in biopsy proven cases of graft pyelonephritis. Indian J Nephrol 2014; 24:161-5. [PMID: 25120293 PMCID: PMC4127835 DOI: 10.4103/0971-4065.132009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The incidence, risk factors and outcome of graft pyelonephritis are variably described in literature. All patients who had been transplanted at our center between January 2002 and November 2006 and had presented with acute graft dysfunction were subjected to biopsy. Those patients who had neutrophilic casts and interstitial inflammation with predominant neutrophils were included in the study. Out of the 265 patients, 110 were transplanted in the period and underwent biopsy for graft dysfunction. Out of the 110 patients, 26 had biopsy proven acute graft pyelonephritis (AGPN). Nine patients had early AGPN (within 6 months) and the other 17 had late AGPN. Nearly 19% of patients were culture negative and five patients had no clinical features of urinary tract infection; AGPN being a surprise finding on biopsy. Among the risk factors, only hepatitis C virus infection was significantly associated with AGPN. All patients received 4-6 weeks of antibiotics with at least 3 weeks of parenteral antibiotics. Majority (75%) of our patients experienced relapse of AGPN. Graft function was significantly lower 6 months after onset when compared to baseline, portending a poor outcome for these patients. Out of 26, 7 (27%) of our patients had biopsy features of concomitant acute cellular rejection. The treatment of acute rejection, however, did not improve the outcome.
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Affiliation(s)
- P P Varma
- Department of Nephrology, Army Hospital (R and R), New Delhi, India
| | - A Jairam
- Department of Nephrology, Army Hospital (R and R), New Delhi, India
| | - A K Hooda
- Department of Nephrology, Army Hospital (R and R), New Delhi, India
| | - S Badwal
- Department of Nephrology, Army Hospital (R and R), New Delhi, India
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Camargo L, Esteves A, Ulisses L, Rivelli G, Mazzali M. Urinary Tract Infection in Renal Transplant Recipients: Incidence, Risk Factors, and Impact on Graft Function. Transplant Proc 2014; 46:1757-9. [DOI: 10.1016/j.transproceed.2014.05.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Dorschner P, McElroy LM, Ison MG. Nosocomial infections within the first month of solid organ transplantation. Transpl Infect Dis 2014; 16:171-87. [PMID: 24661423 DOI: 10.1111/tid.12203] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 10/24/2013] [Accepted: 11/26/2013] [Indexed: 12/11/2022]
Abstract
Infections remain a common complication of solid organ transplantation. Early postoperative infections remain a significant cause of morbidity and mortality in solid organ transplant (SOT) recipients. Although significant effort has been made to understand the epidemiology and risk factors for early nosocomial infections in other surgical populations, data in SOT recipients are limited. A literature review was performed to summarize the current understanding of pneumonia, urinary tract infection, surgical-site infection, bloodstream infection, and Clostridium difficult colitis, occurring within the first 30 days after transplantation.
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Affiliation(s)
- P Dorschner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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49
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Ramadas P, Rajendran PP, Krishnan P, Alex A, Siskind E, Kadiyala A, Jayaschandran V, Basu A, Bhaskaran M, Molmenti EP. Extended-spectrum-beta-lactamase producing bacteria related urinary tract infection in renal transplant recipients and effect on allograft function. PLoS One 2014; 9:e91289. [PMID: 24637786 PMCID: PMC3956605 DOI: 10.1371/journal.pone.0091289] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 02/08/2014] [Indexed: 11/23/2022] Open
Abstract
Background Urinary tract infection (UTI) is a well-recognized early complication in renal transplant recipients (RTR) and can have significant bearing on their outcome. The recent rise in incidence of extended spectrum beta lactamase (ESBL) producing bacteria causing UTI among RTR poses new and significant challenges in terms of management and outcome. Our aim is to analyze the effect of ESBL producing bacteria causing UTI in these patients and its impact on allograft function. Methods We reviewed the medical records of 147 RTR who were followed at a tertiary care hospital affiliated transplant center between January 2007 and May 2013 and noted five RTR who developed episodes of ESBL producing bacteria related UTI during follow up. Multiple patient characteristics including demographics, immunosuppression, recurrences, allograft function and outcome were analyzed. Results Five patients (3.4%) out of 147 had ESBL producing bacteria related UTI. We found all patients to be above 60 years of age, with three out of five being females, and all five patients had diabetes mellitus. We identified a total of 37 episodes of UTI among these five patients during this period. Two of these patients had elevated creatinine values during the episodes of UTI and three of them developed bacteremia. Of the five patients, four of them had a favorable outcome except for one patient who developed persistent allograft dysfunction. Conclusion RTR are at a higher risk for developing ESBL producing bacteria associated UTI. Early diagnosis along with appropriate and judicious use of antibiotics will ensure long term success in allograft and patient outcome.
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Affiliation(s)
- Poornima Ramadas
- Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America
| | - Prejith P. Rajendran
- Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America
| | - Prathik Krishnan
- Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America
| | - Asha Alex
- Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America
| | - Eric Siskind
- Department of Surgery, North Shore University Hospital, Manhasset, New York, United States of America
| | - Aditya Kadiyala
- Department of Nephrology, North Shore University Hospital, Manhasset, New York, United States of America
| | - Vivek Jayaschandran
- Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America
| | - Amit Basu
- Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America
| | - Madhu Bhaskaran
- Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America
- * E-mail:
| | - Ernesto P. Molmenti
- Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America
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Trickey AW, Crosby ME, Vasaly F, Donovan J, Moynihan J, Reines HD. Using NSQIP to Investigate SCIP Deficiencies in Surgical Patients With a High Risk of Developing Hospital-Associated Urinary Tract Infections. Am J Med Qual 2013; 29:381-7. [DOI: 10.1177/1062860613503363] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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