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McAteer J, Tamma PD. Diagnosing and Managing Urinary Tract Infections in Kidney Transplant Recipients. Infect Dis Clin North Am 2024; 38:361-380. [PMID: 38729666 PMCID: PMC11090456 DOI: 10.1016/j.idc.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
In the article, the authors review antibiotic treatment options for both acute uncomplicated UTI and complicated UTI. In addition, they review alternative regimens which are needed in the setting of drug-resistant pathogens including vancomycin-resistant Enterococcus, -extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales, and carbapenem-resistant Pseudomonas, which are encountered with more frequency.
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Affiliation(s)
- John McAteer
- Division of Pediatric Nephrology, Johns Hopkins University School of Medicine; Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Pranita D Tamma
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Hyun M, Lee JY, Lim KR, Kim HA. Clinical Characteristics of Uncomplicated Acute Pyelonephritis Caused by Escherichia coli and Klebsiella pneumoniae. Infect Dis Ther 2024; 13:581-595. [PMID: 38460083 DOI: 10.1007/s40121-024-00940-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/09/2024] [Indexed: 03/11/2024] Open
Abstract
INTRODUCTION This study compared the clinical characteristics and antimicrobial susceptibility of uncomplicated acute pyelonephritis (APN) caused by Escherichia coli and Klebsiella pneumoniae. METHODS We retrospectively reviewed the medical records of patients with uncomplicated APNs caused by E. coli and K. pneumoniae admitted to Keimyung University Dongsan Hospital between February 2014 and December 2021. RESULTS We enrolled 497 patients (372 with E. coli infection, 125 with K. pneumoniae infection). Male, healthcare-associated infection, solid tumors, liver cirrhosis, chronic renal disease, solid organ transplantation, and antibiotic usage within the last 3 months were more strongly associated with K. pneumoniae uncomplicated APNs than with E. coli. Bacteremia and fever occurred more frequently in E. coli uncomplicated APNs. Antimicrobial resistance rates to piperacillin/tazobactam and carbapenem were higher in K. pneumoniae. Antimicrobial resistance rates to aztreonam and ciprofloxacin were lower in K. pneumoniae. Thirty-day mortality was more observed in K. pneumoniae group in univariate analysis, but this difference was not observed after adjustment. Male sex, ultimately fatal disease in McCabe, and prior antibiotic use within 3 months were more associated with K. pneumoniae. CONCLUSIONS Male, underlying diseases, and prior antibiotic use was more associated with K. pneumoniae. Further study will be needed that microbiome of each situation and the related with the distribution of the strains.
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Affiliation(s)
- Miri Hyun
- Department of Infectious Diseases, Keimyung University Dongsan Hospital, School of Medicine & Institute for Medical Science, Keimyung University, Keimyung University, 1035 Dalgubeol-daero, Dalseogu, Daegu, 42601, South Korea
| | - Ji Yeon Lee
- Department of Infectious Diseases, Keimyung University Dongsan Hospital, School of Medicine & Institute for Medical Science, Keimyung University, Keimyung University, 1035 Dalgubeol-daero, Dalseogu, Daegu, 42601, South Korea
| | - Kyong Ree Lim
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892 Dongnam-ro, Gangdonggu, Seoul, 05278, South Korea
| | - Hyun Ah Kim
- Department of Infectious Diseases, Keimyung University Dongsan Hospital, School of Medicine & Institute for Medical Science, Keimyung University, Keimyung University, 1035 Dalgubeol-daero, Dalseogu, Daegu, 42601, South Korea.
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Nascimento EHG, Nascimento E, Lasmar MF, Fabreti-Oliveira RA. Effects of Bacterial Urinary Tract Infection on Clinical Outcome and Survival of Kidney Transplant Patients. Transplant Proc 2022; 54:1262-1269. [PMID: 35781159 DOI: 10.1016/j.transproceed.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/13/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND There is no consensus on whether the development of urinary tract infections (UTIs) leads to high mortality or graft loss in kidney transplant patients. A high incidence of multidrug resistant (MDR) infections was observed worldwide and is associated with these complications. The aim of this study was to analyze the effects of UTIs on the clinical outcome and survival in kidney transplant patients. METHODS This retrospective study evaluated 601 kidney transplant patients who were categorized as follows: group 1 (G1) patients without a UTI, group 2 (G2) patients with a UTI, and group 3 (G3) recipients with a recurrent UTI. Patients were followed up for at least 1 year after transplantation. Graft survival, risk of graft loss, and risk of developing a UTI were analyzed by the Kaplan-Meier method, Cox regression, and logistic regression methods, respectively. Differences with P < .05 were considered statistically significant. RESULTS The proportion of rejection episodes was higher in G3 (32.35%) than in G1 (20.89%) and G2 (21.88%) (P < .001). The graft survival after the 10-year follow-up was better in G1 (73.29%) than in G3 (61.62%) (P = .019). UTI recurrent episodes increased the risk of graft loss >2.5-fold. Women and those who received a kidney from a deceased donor (DD) were at risk of at least 1 UTI event during follow-up. A greater proportion of MDR infections was observed in G3 than in G2 (P < .001). CONCLUSIONS The risk factors for developing a UTI were female sex, receiving a DD kidney, susceptibility to other infections, episodes of rejection, and delayed graft function. Moreover, a UTI, especially a recurrent UTI, was an important risk factor for allograft loss.
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Affiliation(s)
- Edson Henrique Gabriel Nascimento
- University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil; Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil
| | - Evaldo Nascimento
- IMUNOLAB - Laboratory of Histocompatibility, Belo Horizonte, Minas Gerais, Brazil; Institute of Research and Education of the Hospital Santa Casa, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus F Lasmar
- University Hospital of the Faculty of Medical Science, Belo Horizonte, Minas Gerais, Brazil; Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil
| | - Raquel A Fabreti-Oliveira
- Faculty of Medical Sciences, Belo Horizonte, Minas Gerais, Brazil; IMUNOLAB - Laboratory of Histocompatibility, Belo Horizonte, Minas Gerais, Brazil.
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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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Gong L, Zhang L, Liu X, Odilov B, Li S, Hu Z, Xiao X. Distribution and Antibiotic Susceptibility Pattern of Multidrug-Resistant Bacteria and Risk Factors Among Kidney Transplantation Recipients with Infections Over 13 Years: A Retrospective Study. Infect Drug Resist 2022; 14:5661-5669. [PMID: 34992392 PMCID: PMC8713706 DOI: 10.2147/idr.s318941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/11/2021] [Indexed: 11/23/2022] Open
Abstract
Background Infection ranks as the most common complication after kidney transplantation (KT) and threatens outcomes of kidney transplantation recipients (KTR). This study aimed to investigate the microbiological profile of infection, assess bacterial resistance and identify risk factors for multidrug-resistant (MDR) bacterial infection among KTR. Methods During the study period, 866 recipients underwent kidney transplant surgery. We studied the distribution of pathogens, resistance rate of MDR bacteria and the risk factors of MDR bacterial infection. Results Totally, 214 species of pathogens (110 species were MDR bacteria) were isolated in 119 KTR. Escherichia coli (E. coli) was the most common bacteria of the infection. MDR extended spectrum β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) were most resistant to ampicillin, cefazolin, ciprofloxacin and complex sulfamethoxazole, while quite sensitive to imipenem, amikacin and piperacillin/tazobactam (PIT). All MDR gram-positive bacteria were quite sensitive to linezolid and vancomycin, except that MDR Staphylococcus was also susceptible to rifampicin. Female gender (OR = 3.497, 95% CI = 1.445–8.467, P = 0.006), pathogen types > 1 (OR = 3.832, 95% CI = 1.429–10.273, P = 0.008) and postoperative time < 3 months (OR = 0.331, 95% CI = 0.137–0.799, P = 0.014) were independent risk factors for MDR bacterial infection. Conclusion PIT and amikacin may be an alternative choice of ESBL-E infection. Rifampicin can also be prescribed for MDR Staphylococcus infection. MDR bacterial infection was associated with female gender, pathogen types more than 1 and 3 months postoperative period.
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Affiliation(s)
- Liying Gong
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Luwei Zhang
- Department of Organ Transplantation, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Xiaoli Liu
- Department of Kidney Transplantation, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Bekzod Odilov
- Department of Endocrinology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Shengnan Li
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Zhao Hu
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, People's Republic of China
| | - Xiaoyan Xiao
- Department of Nephrology, Qilu Hospital of Shandong University, Jinan, People's Republic of China
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Pagani N, Corcione S, Lupia T, Scabini S, Filippini C, Angilletta R, Shbaklo N, Mornese Pinna S, Romagnoli R, Biancone L, Cavallo R, Di Perri G, Solidoro P, Boffini M, De Rosa FG. Carbapenemase-Producing Klebsiella pneumoniae Colonization and Infection in Solid Organ Transplant Recipients: A Single-Center, Retrospective Study. Microorganisms 2021; 9:microorganisms9112272. [PMID: 34835398 PMCID: PMC8626028 DOI: 10.3390/microorganisms9112272] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/23/2021] [Accepted: 10/25/2021] [Indexed: 12/29/2022] Open
Abstract
Carbapenemase-KPC producing Klebsiella pneumoniae (CP-Kp) infection represents a serious threat to solid organ transplant (SOT). All patients admitted between 1 May 2011 and 31 August 2014 undergoing SOT were included in the retrospective study. The primary outcomes included a description of the association of enteric colonization and invasive infections by CP-Kp with one-year mortality. Secondary outcomes were the study of risk factors for colonization and invasive infections by CP-Kp. Results: A total of 5.4% (45/828) of SOT recipients had at least one positive rectal swab for CP-Kp, with most (88.9%) occurring after transplantation. 4.5% (35/828) of patients developed a CP-Kp-related invasive infection, with 68.6% (24/35) being previously colonized. The 1-year mortality was 31.1% in patients with enteric colonization with CP-Kp and, it was 51.4% among patients with CP-Kp-related invasive infections. At univariate analysis, colonization, invasive infections, sepsis, severe sepsis, and septic shock were significantly associated with 1-year mortality. At multivariate analysis, only invasive infections and the combination of sepsis, severe sepsis, or septic shock were significantly associated with 1-year mortality, whereas gastrointestinal colonization was significantly associated with survival. In this population, the 1-year mortality was significantly associated with invasive infections; otherwise, gastrointestinal colonization was not associated with increased 1-year mortality.
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Affiliation(s)
- Nicole Pagani
- St Stephen’s Centre, Chelsea and Westminster Hospital, 252 Fulham Rd., London SW10 9NA, UK; (N.P.); (G.D.P.)
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
- Department of Medical Sciences, Tufts University School of Medicine, Boston, MA 02109, USA
| | - Tommaso Lupia
- Infectious Disease Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
- Correspondence: ; Tel.: +39-014-148-6404
| | - Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
| | - Claudia Filippini
- Clinical Statistics, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy;
| | - Roberto Angilletta
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
| | - Nour Shbaklo
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
| | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
| | - Renato Romagnoli
- General Surgery 2U, Liver Transplant Center, AOU Città Della Salute e Della Scienza di Torino, University of Turin, 10100 Turin, Italy;
| | - Luigi Biancone
- S.C. Nefrologia, Dialisi e Trapianto U, AOU Città Della Salute e Della Scienza, 10100 Turin, Italy;
| | - Rossana Cavallo
- Microbiology and Virology Unit, University of Turin, 10100 Turin, Italy;
| | - Giovanni Di Perri
- St Stephen’s Centre, Chelsea and Westminster Hospital, 252 Fulham Rd., London SW10 9NA, UK; (N.P.); (G.D.P.)
| | - Paolo Solidoro
- Cardiovascular and Thoracic Department, Pneumology Unit U, AOU Città Della Salute e Della Scienza di Torino, 10100 Turin, Italy;
| | - Massimo Boffini
- Division of Cardiac Surgery, Department of Surgical Sciences, Città Della Salute e Della Scienza, University of Turin, 10100 Turin, Italy;
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10100 Turin, Italy; (S.C.); (S.S.); (R.A.); (N.S.); (S.M.P.); (F.G.D.R.)
- Infectious Disease Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
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Castañeda-Millán DA, Osorio-Iriarte JC, Alzate-Granados JP, Amórtegui-Rodríguez D, Arbeláez-Teuzaba JS, Romero-Sánchez MC, Flórez-Barbosa K, Fajardo-Cediel W. Caracterización de la infección urinaria y resistencia antimicrobiana en receptores de trasplante renal de un centro colombiano. Rev Urol 2021. [DOI: 10.1055/s-0041-1730360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ResumenLa infección del tracto urinario (ITU) es una de las principales complicaciones postrasplante renal, los datos a nivel nacional en ese grupo poblacional son limitados.
Objetivos caracterizar la microbiología de las ITU presentadas en receptores de trasplante renal (TxR) en un centro colombiano durante el periodo 2017–2019, los factores relacionados con la resistencia antimicrobiana y el impacto de la ITU en la función del injerto renal.
Métodos estudio de corte transversal ejecutado mediante el análisis de la base de datos de ingresos hospitalarios por urgencias de pacientes receptores de TxR con sospecha clínica de ITU en una institución de cuarto nivel en Bogotá, Colombia. El análisis de datos se ejecutó en STATA 13.0.
Resultados La ITU causó 12,69% de visitas a urgencias en pacientes trasplantados. Los microorganismos aislados fueron: Escherichia coli 52,22%, Klebsiella pneumoniae 16,67%, Pseudomonas aeruginosa 4,44%, Salmonella spp 4,44%, Proteus mirabilis 3,33%, Serratia marcescens 2,22%, Klebsiella oxytoca 2,22%, Citrobacter koseri 1,11%, Enterobacter cloacae 1,11%, otros 2,22%; El urocultivo fue negativo en 10% de los casos. El 28,39% (n:23) de gérmenes aislados fue multisensible mientras que el 71,60% (n:58) expresó algún tipo de patrón de resistencia distribuido así: 68,96% productor de betalactamasa de espectro extendido (BLEE), 15,52% productor de carbapenemasas, 12,06% productor de betalactamasa tipo IRT, 3,45% fue catalogado como multirresistente. 17,78% de los pacientes presentó criterios de urosepsis, no se registró ningún caso de mortalidad asociada a la ITU. La creatinina sérica tuvo un incremento promedio de 0,46 mg/dl durante el episodio de ITU (p: <0,0001) y el antecedente de diabetes mellitus se relacionó con la ITU causada por gérmenes resistentes (p: 0,008).
Conclusiones La ITU es una causa frecuente de atención en urgencias para pacientes receptores de TxR; la Escherichia coli es el microorganismo causal más frecuente y cerca del 70% de los gérmenes aislados presentó algún patrón de resistencia antimicrobiana.
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Affiliation(s)
- David Andrés Castañeda-Millán
- Unidad de Urología, Facultad de Medicina. Universidad Nacional de Colombia. (Bogotá, Colombia)
- Grupo de Investigación e Innovación en Urología, Departamento de Cirugía. Facultad de Medicina. Universidad Nacional de Colombia. (Bogotá, Colombia)
| | | | - Juan Pablo Alzate-Granados
- Grupo de Investigación e Innovación en Urología, Departamento de Cirugía. Facultad de Medicina. Universidad Nacional de Colombia. (Bogotá, Colombia)
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Freire MP, Carvalho LB, Reusing JO, Spadão F, Lopes MIBF, Nahas WC, David-Neto E, Pierrotti LC. Carbapenem-resistant Enterobacteriaceae among kidney transplant recipients - insights on the risk of acquisition and CRE infection. Infect Dis (Lond) 2021; 53:430-439. [PMID: 33612056 DOI: 10.1080/23744235.2021.1887511] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Kidney transplant recipients are a risk group for carbapenem-resistant Enterobacteriaceae infection. OBJECTIVES This study aimed to identify risk factors for CRE acquisition and infection among kidney transplant recipients. METHODS We conducted a case-control study; we defined the case as kidney transplant recipient with positive culture for carbapenem-resistant Enterobacteriaceae identified between January 2010 and February 2019. Controls were chosen among kidney transplant recipients hospitalized in the same period of cases (1:2). Surveillance culture for carbapenem-resistant Enterobacteriaceae was performed at admission and weekly during hospital stay. The risk factors analysis for carbapenem-resistant Enterobacteriaceae infection was performed among patients colonized by these bacteria. RESULTS We identified 331 patients colonized with carbapenem-resistant Enterobacteriaceae; The median time from transplantation to first carbapenem-resistant Enterobacteriaceae positive culture was 42 days (range from 3 to 7399 days); 125(37.8%) patients developed infection; the most common site was urinary tract. Risk factors for carbapenem-resistant Enterobacteriaceae acquisition were recipient age >45-year, diabetes nephropathy, donor age >55-year, ureteral stent at kidney transplantation, delay of graft function, median lymphocytes count <800cells/mm3, and acute cellular rejection. Risk factors for carbapenem-resistant Enterobacteriaceae infection were recipient age at CRE acquisition >50-year; median lymphocytes count ≤700 cells/mm3, carbapenem use, and colonization by polymyxin-resistant strain. Patients colonized by polymyxin and carbapenem resistant Enterobacteriaceae strain who used carbapenem had a 93.8% probability of developing infection by this agent. CONCLUSION Carbapenem-resistant Enterobacteriaceae acquisition after kidney transplant is related to graft conditions, immunosuppression degree. Among carbapenem-resistant Enterobacteriaceae colonized patients, special attention is needed for those harbouring polymyxin-resistant strains.
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Affiliation(s)
- Maristela P Freire
- Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Laina B Carvalho
- Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Jose Otto Reusing
- Department of Urology, Renal Transplantation Unit, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Fernanda Spadão
- Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Max Igor B F Lopes
- Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - William C Nahas
- Department of Urology, Renal Transplantation Unit, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Elias David-Neto
- Department of Urology, Renal Transplantation Unit, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
| | - Ligia C Pierrotti
- Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW Carbapenem-resistant enterobacteriaceae (CRE) are a critical healthcare threat. Infections caused by CRE disproportionately affect transplant patients. Retrospective case studies suggest that up to 10% of transplant recipients develop a CRE infection. The current literature is reviewed with a particular focus on transplant-specific implications. RECENT FINDINGS There are specific risks inherent to transplant recipients that result in an elevated risk for CRE carriage and subsequent infection. Additionally, the manifestations of these infections are dependent on the specific transplant type. The optimal treatment of CRE infections in transplant recipients has not been defined. SUMMARY A reduction in the regional community CRE burden can lead to a secondary reduction in their occurrence within vulnerable transplant populations. Therefore, core principles of antibiotic stewardship and infection control within all levels of the healthcare system remains the most effective strategy for addressing the current health crisis. Simultaneously, an integrated approach to risk stratification and an approach to treatment is postulated for management of CRE infection within the solid-organ transplant population.
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Aydın S, Patil A, Desai M, Simforoosh N. Five compelling UTI questions after kidney transplant. World J Urol 2020; 38:2733-2742. [PMID: 32266510 DOI: 10.1007/s00345-020-03173-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/17/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Urinary tract infection (UTI) is the most common bacterial infection among infectious complications in kidney transplant recipients (KTR). After transplantation, infections can result from surgical complications, donor-derived infections, pre-existing recipient infections, and nosocomial infections. Post-transplant infection is still a major cause of morbidity, mortality, graft dysfunction and rejection. In this paper, we aimed to review a few compelling questions in kidney transplantation (KTX). METHODS To identify relevant clinical questions regarding KTX and UTI a meeting was conducted among physicians involved in the KT program in our hospital. After discussion, several clinically relevant questions related to UTI after KTX. The 5 first rated in importance were judged generalizable to other clinical settings and selected for the purposes of this review. RESULTS Nearly half of the patients present in the first three months of transplant with UTI. The most common uropathogens in post-transplant UTIs are Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Risk factors for UTI include female sex, advanced age, recurrent UTI before transplant, prolonged urethral catheterization, delayed graft function, and cadaveric kidney transplant. CONCLUSION The incidence of post-transplant UTI is similar in both developed and developing countries. E.coli is the most common pathogen in most of studies. Cadaveric donor and post-dialysis transplantation are defined as independent risk factors for post-transplant UTI. Further studies are still required to identify risk factors after kidney transplantation and UTI's importance for graft function and patient outcome.
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Affiliation(s)
- Selda Aydın
- Infectious Diseases and Clinical Microbiology, Medipol Mega Hospital, Istanbul Medipol University School of Medicine, Bağcılar, Istanbul, Turkey.
| | - Abhijit Patil
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Nasser Simforoosh
- Department of Urology, Shahid Labbafinejad Medical Center, Tehran, Iran
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