Influence of Double-J Catheters on Urinary Infections After Kidney Transplantation

Prospective Evaluation of Antibiotic Management in Ureteral Stent and Nephrostomy Interventions

INTRODUCTION

Screening for and treating asymptomatic bacteriuria (ABU) or administering antibiotic prophylaxis is recommended during ureteral stent and nephrostomy interventions. This study investigates the frequency of postinterventional infectious complications to gain insight into the need for antibiotics.

METHODS

Between September 2016 and June 2019, 168 insertions/exchanges of ureteral stents or nephrostomies were recorded in a prospective multicenter study. Patients without a symptomatic UTI did not receive antibiotic treatment/prophylaxis. Asymptomatic patients in whom their urologist already administered an antibiotic treatment served as a comparative group. Follow-up included postinterventional complications within 30 days. Symptoms were assessed by the Acute Cystitis Symptom Score (ACSS) before and after the intervention. Predictors of increasing postinterventional symptoms were analyzed by a multivariable logistic regression model.

RESULTS

One hundred forty-five interventions were eligible. One hundred twenty-two (84.1%) interventions were performed without antibiotic treatment. Preinterventional ABU was detected in 54.4% and sterile urine in 22.8% (22.8% without culture). Postinterventional infectious complications did not differ between patients with versus without antibiotics. Transurethral interventions aggravate symptoms (p = 0.034) but do not increase infectious complications compared to percutaneous interventions. Patients without diabetes mellitus are at higher risk for increasing symptoms.

CONCLUSION

Results indicate that peri-interventional antibiotic treatment may be omitted in patients without symptomatic UTI. Symptoms must be differentiated between infectious and procedure-associated origins.

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

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.

Urinary tract infection and antibiotic use around ureteral stent insertion for urolithiasis

Urolithiasis is the main indication for a ureteral JJ stent. Our aim was to determine the incidence of urinary tract infections (UTIs) after a JJ stent for urolithiasis, with an emphasis on antibiotic use. Prospective, multicenter, cohort study over a 4-month period including all of the patients with urolithiasis requiring JJ stent insertion. The clinical and microbiological data and therapeutic information were recorded until removal of the JJ stent. Two hundred twenty-three patients at five French private hospitals were included. A urine culture was performed for 187 patients (84%) prior to insertion of a JJ stent, 36 (19%) of which were positive. One hundred thirty patients (58%) received an antibiotic therapy during surgery: 74 (33%) prophylaxis and 56 (25%) empirical antibiotic therapy, comprising 17 different regimens. The rate of prophylaxis varied according to the center, from 0 to 70%. A total of 208 patients were followed-up until removal of the first stent. The rate of UTIs was 6.3% (13/208); 8.1% of the patients who did not receive a prophylaxis had a UTI versus 1.4% of those who did receive a prophylaxis (p = 0.057). Seven empirical antibiotic regimens were used to treat these 13 patients. Another large panel of antibiotic prescriptions was observed at the time of JJ stent removal. The incidence of a UTI after JJ stent insertion for urolithiasis was 6.3%, in part due to a lack of prophylaxis. An unwarranted diversity of antibiotic use was observed at each step of care.

Evaluation of early and late-term infections after renal transplantation: Clinical experiences of Sanko University Medical Faculty Transplantation Center

OBJECTIVE

Infections play an important part in post-transplantation causes of morbidity and mortality. The purpose of this study is to evaluate short-, and long-term infections encountered in after renal transplantations.

MATERIAL AND METHODS

Two hundred and thirteen cases that consisted of both living and cadaver donors, who suffered from late period renal insufficiency and had renal transplant between June 2011 and January 2016 at the Transplantation Center of Sanko University School of Medicine were included in the study. In this study the short-, and long-term infections seen in post renal transplantation were examined retrospectively. Infection types, frequency and periods of infection, infection agents and predisposing factors were determined as the examination parameters.

RESULTS

Of the 213 patients who received renal transplant, 139 were males (65.3%) and 74 were women (34.75%) and the mean age was 42±11,8 (range, 14-70) years. Twelve (5.6%) patients exited after renal transplantation. Post-transplant infections were seen in 49 patients (23.1%) within 1-6 months; in 13 patients (6.1%) within 6-12 months; and in 5 patients (2.4%) after the 12^th month. The most common infections after renal transplantation were associated with urinary tract (70 patients, 34.3%). The most frequently isolated agents were E. coli (n=66; 30.9%), Kebsiella spp. (n=18; 8.4%) and Enterococci (n=18; 8.4%) respectively. The renal transplants from the cadavers were observed to contract infections 1.78 times more frequently compared to the living donors (OR=1.78, 95% CI=1.03-3.09).

CONCLUSION

The most common complication after renal transplantation are infections. The majority of the infections are seen within the first year especially between 1-6 months. Post-transplant infections are often related to urinary system. E.coli is the most frequently isolated agent and it may be responsible for urosepsis in renal transplant patients. Infection more often seen in renal transplantations from cadavers.