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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: 6] [Impact Index Per Article: 6.0] [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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Liu T, Yao Y, Xing X, Chu D. Effects of Continuous Catheterization on Reducing Postoperative Urinary Tract Infection in Cervical Cancer Patients with Double J Stent Placement. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:9299001. [PMID: 34795888 PMCID: PMC8594985 DOI: 10.1155/2021/9299001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/01/2021] [Accepted: 10/22/2021] [Indexed: 11/18/2022]
Abstract
This study aims at exploring the effect of continuous catheterization on reducing postoperative urinary tract infection in cervical cancer patients with double J tube placement. To be specific, a retrospective analysis was performed on 120 cases of cervical cancer patients who underwent laparoscopic or open radical hysterectomy in Shengjing Hospital of China Medical University from January to December 2019. They were divided into a persistent group (n = 70) and a short-term group (n = 50) according to indwelling catheter time. The incidence of postoperative complications and the positive rate of bacterial culture in bladder urine and double J tube bacterial culture were compared between the two groups. As a result, it was found that the incidence of postoperative fever and urinary tract infection in the short-term group was significantly higher than that in the persistent group (P < 0.05). There was no significant difference in the incidence of postoperative hematuria, bladder stimulation, and urinary system injury between the two groups. The positive rate of double J tube bacterial culture in both groups was also proved to be higher than that in bladder culture, and the difference was statistically significant (P < 0.05). And in the short-term group (P < 0.05), the difference in the positive rate of bladder culture between the two groups was not statistically significant. To conclude, we found that continuous catheterization can reduce the incidence of postoperative urinary tract infection in cervical cancer patients with double J tube placement, which might be helpful for the treatment of cervical cancer.
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Affiliation(s)
- Tengteng Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yuan Yao
- Department of Oncology, The People's Hospital of Liaoning Province, Shenyang 110016, China
| | - Xinwen Xing
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Daming Chu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, China
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Association Between the Placement of a Double-J Catheter and the Risk of Urinary Tract Infection in Renal Transplantation Recipients: A Retrospective Cohort Study of 1038 Patients. Transplant Proc 2021; 53:1927-1932. [PMID: 34229904 DOI: 10.1016/j.transproceed.2021.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/11/2021] [Accepted: 05/04/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The incidence of urinary complications in transplantation is 2% to 20%, which can be decreased with the use of a double-J catheter. The objective of this study was to determine the association between the use of the catheter and the probability of urinary tract infection (UTI). METHODS We studied a retrospective cohort of 1038 patients divided into 2 groups: those treated with vs without a double-J catheter. Perioperative factors related to catheter use were analyzed. Second, whether the use of the catheter was associated with fewer other urinary complications was analyzed. RESULTS Of the whole sample, 72 patients were eliminated from the study, and 358 (37%) received a double-J catheter. UTIs occurred in 190 patients (19.6%), of whom a greater proportion received a catheter: 88 of 358 (24.6%) vs 102 of 608 (16.8%) (odds ratio, 1.61; 95% confidence interval, 1.17-2.22; P = .003). CONCLUSIONS The placement of a double-J catheter during transplant is associated with a higher proportion of UTIs, increasing their severity and the cost of care, without having a clear effect on other types of urinary complications.
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Recommendations of the AFU Infectious Diseases Committee on the prevention, diagnosis and treatment of infections of endo-ureteral equipment. Prog Urol 2021; 31:557-575. [PMID: 34154957 DOI: 10.1016/j.purol.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 12/06/2020] [Accepted: 02/11/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION No recent national guidelines exist regarding the management of urinary tract infections (UTIs) in the presence of ureteral stent. This situation could lead to discrepancies in clinical management and less opportunity for a favorable patient's outcome. METHODS All available data published on Medline® between 1998 and 2018 were systematically searched and reviewed. All papers assessing adult patients carrying ureteral stent were included for analysis. After studies critical analysis, national guidelines for clinical management were elaborated in order to answer clinical questions. RESULTS A total of 451 articles were identified, of which 58 have been included. The prevalence of urinary tract infections in the presence of ureteral stent remains unknown. After 3 months, all endo-ureteral devices were colonized on microbiological study. These patients also presented a positive urine culture in 25 to 70% of the cases, often polymicrobial. Staphylococci, E. coli, Klebsiella, Pseudomonas, Enterococcus and Candida were the commonest micro-organisms responsible for urinary colonization or infection. The risk of UTI on endo-ureteral devices seemed higher the longer it stayed implanted. There is no justification in the literature to recommend a systematic change of endo-ureteral devices following a urinary tract infection. DISCUSSION The existing literature is rich but of poor methodological quality, and therefore does not allow to draw robust conclusions. The greatest difficulty faced in this work was to accurately differentiate urinary colonizations from true infections, including clinical symptoms and not only microbiological results. CONCLUSION These guidelines propose a standardized management of such common clinical situations. Well-designed studies are needed to upgrade the level of evidence of these guidelines.
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Cylke R, Karpeta E, Bieniasz M, Kosieradzki M. Urologic Complications After Transplantation of Kidneys With Duplicated Ureter: A Retrospective Study. Transplant Proc 2019; 51:779-782. [PMID: 30979464 DOI: 10.1016/j.transproceed.2018.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/09/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Duplication of ureters is a common anatomic abnormality and occurs in 0.7% to 1% of the general population. In this article we focus on the safety of using of kidneys with complete ureteral duplication, provided no hydronephrosis or ureterocele was present in the donor. METHODS From 1998 to March 2018 there were 1965 kidneys transplanted at our institution, including 27 kidneys with duplicated ureter, which corresponds to incidence of 1.4%. Patients' medical records, surgery protocols, and Poltransplant registries were searched for urinary complications. RESULTS In the double ureter group, urologic complications occurred in 4 patients (15.4%). Similarly, severe urinary complications developed in 4 patients from the control group (17.4%). CONCLUSIONS Transplantation of kidneys with duplicated ureters appears to be a safe and feasible procedure.
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Affiliation(s)
- R Cylke
- Department of General and Transplant Surgery of the Infant Jesus Teaching Hospital in Warsaw, Poland.
| | - E Karpeta
- Department of General and Transplant Surgery of the Infant Jesus Teaching Hospital in Warsaw, Poland; Department of Surgical and Transplantation Nursing and Extracorporeal Therapies of Warsaw, Poland
| | - M Bieniasz
- Department of General and Transplant Surgery of the Infant Jesus Teaching Hospital in Warsaw, Poland
| | - M Kosieradzki
- Department of General and Transplant Surgery of the Infant Jesus Teaching Hospital in Warsaw, Poland
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Kırnap M, Boyvat F, Torgay A, Moray G, Yıldırım S, Haberal M. Incidence of Urinary Complications With Double J Stents in Kidney Transplantation. EXP CLIN TRANSPLANT 2019; 17:148-152. [DOI: 10.6002/ect.mesot2018.p14] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kumar V, Punatar CB, Jadhav KK, Kothari J, Joshi VS, Sagade SN, Kamat MH. Routine double-J stenting for live related donor kidney transplant recipients: It doesn't serve the purpose, but does it serve a better purpose? Investig Clin Urol 2018; 59:410-415. [PMID: 30402574 PMCID: PMC6215780 DOI: 10.4111/icu.2018.59.6.410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 09/19/2018] [Indexed: 01/25/2023] Open
Abstract
Purpose Despite meticulous techniques, surgical complications continue to be problematic in kidney transplant recipients. Role of routine stenting to reduce complications is controversial. In this study, we compare incidence of early urological complications, lymphoceles, urinary tract infections (UTI) and graft function; with or without double-J stenting. Materials and Methods All patients who underwent live related donor renal transplantation from February 2014 to February 2016 were included. Transplants prior to February 2015 were without routine stenting; subsequent transplants were with routine stenting. Patients with neurogenic bladder, previously operated bladder and delayed or low urinary output were excluded. Follow-up was for at least three months. Descriptive statistics was performed for all parameters. Chi square test and Fisher's Exact test were used for qualitative variables. For quantitative variables, Mann-Whitney test was used to test median difference and independent samples t-test for mean difference. The p-value ≤0.05 was considered significant. Results We analysed 74 patients (34 stented and 40 non-stented). There was no difference in the incidence of urinary leak, anastomotic obstruction, lymphoceles or UTI (p>0.4 for all comparisons). However, mean estimated glomerular filtration rate at sixth day, 14th day, one month and two months were 76.1 vs. 61.5 (p=0.025), 72.1 vs. 56.6 (p=0.005), 79.4 vs. 63.1 (p=0.002) and 82.0 vs. 63.3 (p=0.001) in the stented versus non-stented groups. Conclusions Placement of ureteral stent in renal transplant does not significantly affect the incidence of early urinary complications or UTI. However, graft function is significantly better in stented recipients, at least in the short term.
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Affiliation(s)
- Vikash Kumar
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Chirag B Punatar
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Kunal K Jadhav
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Jatin Kothari
- Department of Nephrology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Vinod S Joshi
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Sharad N Sagade
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Madhav H Kamat
- Department of Urology, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India
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Urinary Tract Infections in the First Year Post–Kidney Transplantation: Potential Benefits of Treating Asymptomatic Bacteriuria. Transplant Proc 2017; 49:2070-2075. [DOI: 10.1016/j.transproceed.2017.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/30/2017] [Indexed: 02/06/2023]
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Yuksel Y, Tekin S, Yuksel D, Duman I, Sarier M, Yucetin L, Kiraz K, Demirbas M, Kaya Furkan A, Aslan Sezer M, Demirbas A, Asuman YH. Optimal Timing for Removal of the Double-J Stent After Kidney Transplantation. Transplant Proc 2017; 49:523-527. [PMID: 28340826 DOI: 10.1016/j.transproceed.2017.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Urologic complications (UC) have gradually decreased in recent years after advanced surgical experience. The incidence of urologic complications varies between 0.22% and 30% in different medical studies. There is no routine usage of double-J stenting (DJS) during renal transplantation (RT) in the literature. It is a necessity, and optimal timing for stent removal is an important question for many transplantation centers. METHODS This study includes 818 renal transplant patients whose ureteroneocystostomy anastomoses were completed by use of the Lich-Gregorie procedure during a 2-year period at a transplantation center. We performed 926 renal transplantations at Antalya Medical Park Hospital Renal Transplantation Center between January 2014 and January 2016. The patients were divided into four groups according to the timing of DJS removal. RESULTS For group 1, removal time for DJS was between 5 and 7 days; group 2, Removal time for DJS was between 8 and 14 days; group 3, removal time for DJS was between 15 and 21 days; and group 4, removal time for DJS was later than 22 days. The patients were divided into two groups according to removal time of stent as 5 to 14 days and >15 days. DJS was performed again in the patients whose urine output was reduced during the first 5 days after removal of the DJS, whose creatine level increased, and whose graft ureter and collecting tubules were extended as an ultrasonographic finding. CONCLUSIONS There is no declared optimal time for the removal of DJS. The removal time was reported between postoperative first week and 3 months in some of the reports of RT centers, according to their protocols. We emphasize that the optimal time for the removal of DJS is 14 to 21 days after RT, based on the findings of our large case report study.
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Affiliation(s)
- Y Yuksel
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey.
| | - S Tekin
- Kemerburgaz University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | - D Yuksel
- Training and Research Hospital, Department of Anesthesia and Reanimasyon Unit, Antalya, Turkey
| | - I Duman
- Kemerburgaz University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - M Sarier
- Kemerburgaz University, Faculty of Medicine, Department of Urology, Istanbul, Turkey
| | - L Yucetin
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - K Kiraz
- Ataturk Goverment Hostpital, Department of Chest Diseases, Antalya, Turkey
| | - M Demirbas
- Yuksek Ihtisas Training and Research Hospital, Department of Urology, Bursa, Turkey
| | - A Kaya Furkan
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - M Aslan Sezer
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - A Demirbas
- Medical Park Hospital, Department of General Surgery and Transplantation, Antalya, Turkey
| | - Y H Asuman
- Medical Park Hospital, Department of Nephrology and Transplantation, Antalya, Turkey
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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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Argyrou C, Moris D, Vernadakis S. Steering between Scylla and Charybdis: Picking out the optimum time of double-J stent removal following renal transplantation. Transplant Rev (Orlando) 2016; 31:96-99. [PMID: 27884503 DOI: 10.1016/j.trre.2016.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
Affiliation(s)
| | - Demetrios Moris
- Department of Immunology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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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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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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14
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Gołębiewska JE, Dębska-Ślizień A, Rutkowski B. Urinary tract infections during the first year after renal transplantation: one center's experience and a review of the literature. Clin Transplant 2014; 28:1263-70. [DOI: 10.1111/ctr.12465] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Justyna E. Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - Alicja Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - Bolesław Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
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Gołębiewska JE, Dębska-Ślizień A, Rutkowski B. Treated asymptomatic bacteriuria during first year after renal transplantation. Transpl Infect Dis 2014; 16:605-15. [DOI: 10.1111/tid.12255] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/18/2014] [Accepted: 03/13/2014] [Indexed: 11/26/2022]
Affiliation(s)
- J. E. Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - A. Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
| | - B. Rutkowski
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
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Akoh JA, Rana T. Effect of ureteric stents on urological infection and graft function following renal transplantation. World J Transplant 2013; 3:1-6. [PMID: 24175202 PMCID: PMC3812932 DOI: 10.5500/wjt.v3.i1.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/08/2012] [Accepted: 12/05/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To compare urological infections in patients with or without stents following transplantation and to determine the effect of such infections on graft function.
METHODS: All 285 recipients of kidney transplantation at our centre between 2006 and 2010 were included in the study. Detailed information including stent use and transplant function was collected prospectively and analysed retrospectively. The diagnosis of urinary tract infection was made on the basis of compatible symptoms supported by urinalysis and/or microbiological culture. Graft function, estimated glomerular filtration rate and creatinine at 6 mo and 12 mo, immediate graft function and infection rates were compared between those with a stent or without a stent.
RESULTS: Overall, 196 (183 during initial procedure, 13 at reoperation) patients were stented following transplantation. The overall urine leak rate was 4.3% (12/277) with no difference between those with or without stents - 7/183 vs 5/102, P = 0.746. Overall, 54% (99/183) of stented patients developed a urological infection compared to 38.1% (32/84) of those without stents (P = 0.0151). All 18 major urological infections occurred in those with stents. The use of stent (Wald χ2 = 5.505, P = 0.019) and diabetes mellitus (Wald χ2 = 5.197, P = 0.023) were found to have significant influence on urological infection rates on multivariate analysis. There were no deaths or graft losses due to infection. Stenting was associated with poorer transplant function at 12 mo.
CONCLUSION: Stents increase the risks of urological infections and have a detrimental effect on early to medium term renal transplant function.
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Mathe Z, Treckmann JW, Heuer M, Zeiger A, Sauerland S, Witzke O, Paul A. Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections? Eur J Med Res 2012; 15:297-302. [PMID: 20696641 PMCID: PMC3351954 DOI: 10.1186/2047-783x-15-7-297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation. Methods We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well. Results A total of 157 patients were enrolled to a stent (ST) and 153 patients to a no-stent (NST) group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65). Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%). Conclusion Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.
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Affiliation(s)
- Zoltan Mathe
- Department of General-, Visceral- and Transplantation Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122 Essen, Germany.
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Vrochides D, Ntinas A, Kardassis D, Miliaras D, Metrakos P, Papalois A. Single-Stitch Telescopic Bilioenterostomy in an Animal Model. J INVEST SURG 2012; 25:317-25. [DOI: 10.3109/08941939.2011.652729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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FTsai S, Shu K, Chen CH. Double J-related hemoperitoneum in a living-related renal transplantation recipien. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:599-601. [PMID: 23115725 PMCID: PMC3482335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 04/07/2012] [Indexed: 11/03/2022]
Affiliation(s)
- Sh FTsai
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - K Shu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - C H Chen
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan ,Department of Life Science, Tunghai University, Taichung, Taiwan ,School of Medicine, Chung Shan Medical University, Taichung, Taiwan ,Correspondence: Cheng-Hsu Chen, M.D., Ph.D Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.Tel.: 886-4-23592525,+98 912 183 7405, Fax: 886-4-23592525, E-mail:
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Gołębiewska J, Dębska-Ślizień A, Komarnicka J, Samet A, Rutkowski B. Urinary tract infections in renal transplant recipients. Transplant Proc 2012; 43:2985-90. [PMID: 21996206 DOI: 10.1016/j.transproceed.2011.07.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Urinary tract infections (UTIs) are most common infections in renal transplant recipients and are considered a potential risk factor for poorer graft outcomes. AIM To evaluate incidence, clinical manifestations, microbiology, risk factors for UTIs, and the influence of UTIs on long-term renal graft function. PATIENTS AND METHODS We analyzed urine cultures with reference to clinical data of patients who received a renal transplantation from January to December 2009 with a 12-month follow-up. RESULTS The 1170 urine cultures were correlated with clinical data from 89 renal transplant recipients, including 58.4% males and on overall mean age of 48±14 years. The 151 episodes in 49 patients consisted of asymptomatic bacteriuria (65%, n=98); lower UTIs (13%, n=19); and upper UTIs (22%, n=34), as well as five cases of bacteremia. Nearly 48% of UTIs were diagnosed during the first month posttransplantation. The most frequently isolated uropathogens were Enterococcus faecium (33%, n=24) and Escherichia coli (31%, n=23). Beginning from the second month, most frequently found bacterium in urine cultures was E coli (65% n=51). Risk factors for posttransplant UTIs were female gender and a history of an acute rejection episode and/or a cytomegalovirus (CMV) infection. All patients with vesicoureteral reflux of strictures at the ureterovesical junction suffered recurrent UTIs (n=7). The evolution of renal graft function did not differ significantly between patients with versus without UTIs. CONCLUSIONS UTIs a frequent problem after kidney transplantation most commonly exist as asymptomatic bacteriuria. E coli and E faecium are ther predominant pathogens. Exposure to intensified immunosuppression due to acute rejection episodes or CMV infections represents a risk factor for UTIs. Vesicoureteral reflux or strictures at the ureterovesical junction are risk factors for recurrent UTIs. UTIs did not impair 1-year graft function.
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Affiliation(s)
- J Gołębiewska
- Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
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Huang L, Wang X, Ma Y, Wang J, Tao X, Liao L, Tan J. A Comparative Study of 3-Week and 6-Week Duration of Double-J Stent Placement in Renal Transplant Recipients. Urol Int 2012; 89:89-92. [DOI: 10.1159/000338075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 03/12/2012] [Indexed: 11/19/2022]
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Abstract
Vesicoureteric complications present early after transplantation and contribute to patient morbidity, graft loss and mortality. Ureteral stenting provides a decrease in ureteroneocystostomy anastomotic complications following renal transplantation. There should be prophylactic stent insertion with endoscopic removal at a designated time post transplantation. With the addition of antibiotic prophylaxis post transplantation, ureteric stenting does not increase the rate of urinary tact infections. There is no significant increase in cost for stenting during transplantation in comparison to management of major ureteric complications. Routine stenting causes significant cost-saving per year and prevents anastomotic complications. It is wise to stent the transplant ureter routinely.
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Affiliation(s)
- Ritesh Mongha
- Departments of Urology and Kidney Transplant, Fortis Hospital, Vasant Kunj, New Delhi-110 070, India
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Luna E, Cerezo I, Abengózar A, Garcia de Vinuesa E, Martínez C, Villa J, Cubero J. Urologic Complications After Kidney Transplantation: Involvement of the Double-J Stent and the Urologic Suture. Transplant Proc 2010; 42:3143-5. [DOI: 10.1016/j.transproceed.2010.05.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Neri F, Tsivian M, Coccolini F, Bertelli R, Cavallari G, Nardo B, Fuga G, Faenza A. Urological Complications After Kidney Transplantation: Experience of More Than 1000 Transplantations. Transplant Proc 2009; 41:1224-6. [DOI: 10.1016/j.transproceed.2009.03.044] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Maheshwari R, Chaturvedi S, Srivastava A. Is routine use of Double-J stent necessary in Renal Transplantation? INDIAN JOURNAL OF TRANSPLANTATION 2009. [DOI: 10.1016/s2212-0017(11)60090-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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