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Herrera-Espejo S, Carretero-Ledesma M, Bahamonde-García MA, Cordero E, Pachón J, Pachón-Ibáñez ME. Assessing the Influence of Urine pH on the Efficacy of Ciprofloxacin and Fosfomycin in Immunocompetent and Immunocompromised Murine Models of Escherichia coli and Klebsiella pneumoniae Infection in the Lower Urinary Tract. Antibiotics (Basel) 2024; 13:827. [PMID: 39335001 PMCID: PMC11429092 DOI: 10.3390/antibiotics13090827] [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: 08/02/2024] [Revised: 08/26/2024] [Accepted: 08/30/2024] [Indexed: 09/30/2024] Open
Abstract
In vitro studies have suggested that acidic pH may reduce and increase the efficacy of ciprofloxacin and fosfomycin, respectively, when used to treat Escherichia coli and Klebsiella pneumoniae infections. We assessed the effects of acidic, neutral, and alkaline urine pH on the efficacy of optimized ciprofloxacin and fosfomycin dosages in UTI murine model of E. coli and K. pneumoniae. Immunocompetent and immunocompromised mice with adjusted urine pH were inoculated with E. coli and K. pneumoniae strains, and the efficacy was assessed based on the bacterial concentrations in tissues and fluids at 72 h, with respect to untreated controls. At acidic urine pH, both antimicrobials were effective, achieving similar reductions in E. coli concentrations in the kidneys in immunocompetent and immunocompromised mice and in K. pneumoniae in immunocompetent mice. At a neutral urine pH, both therapies reduced the presence of E. coli in the kidneys of immunocompetent mice. However, in immunocompromised mice, antimicrobials were ineffective at treating E. coli infection in the kidneys at a neutral urine pH and showed reduced efficacy against K. pneumoniae at both acidic and neutral urine pH. The results showed no correlation between urine pH and antimicrobial efficacy, suggesting that the reduced effectiveness is associated with the animals' immunocompetence status.
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Affiliation(s)
- Soraya Herrera-Espejo
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, 41013 Seville, Spain
| | - Marta Carretero-Ledesma
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, 41013 Seville, Spain
| | - Manuel Anselmo Bahamonde-García
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, 41013 Seville, Spain
| | - Elisa Cordero
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Department of Medicine, School of Medicine, University of Seville, 41004 Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Jerónimo Pachón
- Department of Medicine, School of Medicine, University of Seville, 41004 Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, 41013 Seville, Spain
| | - María Eugenia Pachón-Ibáñez
- Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, 28029 Madrid, Spain
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Hung DD, Dung LT, Van Sy T, Khuyen PH, Duy NQ, Vu LN, Nghia NQ, Cuong NT. Arteriovenous malformation in the kidney allograft: A rare cause of hematuria in the post-transplant patient. Radiol Case Rep 2024; 19:3820-3823. [PMID: 38983311 PMCID: PMC11231646 DOI: 10.1016/j.radcr.2024.05.082] [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: 01/28/2024] [Revised: 05/22/2024] [Accepted: 05/26/2024] [Indexed: 07/11/2024] Open
Abstract
Gross hematuria is one of the most common complications in postrenal transplant patients, accounting for 12% of all renal recipients. The management plan in these cases varies depending on different entities, including infection, renal cell carcinoma, chronic graft rejection, kidney calculus, or recurrence of primary disease. On the other hand, vascular malformation like arteriovenous malformation was less likely to be mentioned due to a lack of consensus in the natural history, pathogenesis, and current management. In this article, we report a 62-year-old man presenting with spontaneous hematuria for a week and 2 days of anuria after 3 years of renal transplantation. Abdominal ultrasound and abdominopelvic computed tomography noted an obstruction of the renal pelvis due to blood clots without signs of vascular injuries. An emergency operation was performed to remove blood clots in the renal pelvis, but after that, hematuria was still recurrence. A digital renal graft subtraction angiography (DSA) revealed an arteriovenous malformation (AVM)in the kidney allograft. This lesion was then successfully selective embolized with glue. Given the high accuracy of DSA, our case highlights the potential role of this imaging modality in diagnosing and treating AVM after failure with other modalities.
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Affiliation(s)
- Duong Duc Hung
- Cardiovascular and Thoracic Center, Viet Duc University Hospital, Viet Nam
- Univeristy of Medicine and Pharmacy (VNU-UMP), Vietnam National University, Ha Noi, Viet Nam
| | - Le Thanh Dung
- Department of Radiology, Viet Duc University Hospital, Ha Noi, Viet Nam
- Deparment of Radiology, Univeristy of Medicine and Pharmacy (VNU-UMP), Vietnam National University, Ha Noi, Viet Nam
| | - Than Van Sy
- Department of Radiology, Viet Duc University Hospital, Ha Noi, Viet Nam
| | - Pham Huu Khuyen
- Department of Radiology, Viet Duc University Hospital, Ha Noi, Viet Nam
| | | | - Le Nguyen Vu
- Organ Transplantation center, Viet Duc University Hospital, Ha Noi, Viet Nam
- Department of Urology, Univeristy of Medicine and Pharmacy (VNU-UMP), Vietnam National University, Ha Noi, Viet Nam
| | - Nguyen Quang Nghia
- Organ Transplantation center, Viet Duc University Hospital, Ha Noi, Viet Nam
| | - Nguyen The Cuong
- Kidney diseases and Hemodialysis, Viet Duc University Hospital, Ha Noi, Viet Nam
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Goodarzi R, Yousefimashouf R, Sedighi I, Moradi A, Taheri M. Effect of thymol on antimicrobial susceptibility, and adhesion genes expression of uropathogenic Escherichia coli isolated from pediatric urinary tract infection. J Pediatr Urol 2023; 19:654.e1-654.e7. [PMID: 37481428 DOI: 10.1016/j.jpurol.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Uropathogenic Escherichia coli (UPEC) is a common cause of urinary tract infections (UTI) in children and currently is one of the leading medical problems. Due to the increase in antibiotic resistance rate, herbal medicines with lower side effects were considered. OBJECTIVE This study aimed to identify the afa, fimH, and sfa genes of UPEC bacteria isolated from pediatric UTI to investigate the effect of the thyme on the expression of fimH gene. STUDY DESIGN In this cross-sectional study, 160 UPEC were isolated from pediatric UTIs. An antibiotic susceptibility test was performed on six families of antibiotics, including beta-lactams, quinolones, aminoglycosides, carbapenems, sulfonamides, and nitrofurantoin. The micro-broth dilution method was used to determine MIC of thymol. The biofilm production ability of isolated strains was quantified by the microtiter plate method. The PCR technique was used to detectfimH, afa, and sfa adhesion genes, and real-time PCR was used to measure the fimHgene expression. RESULTS The results of the antibiogram showed that the lowest and highest resistance related to meropenem and imipenem (zero), and 72.5% for cephalothin. MIC showed 80.7% of the isolates were sensitive to thymol. The biofilm production results showed that 3.12%, 53.75%, and 43.12% of the isolates were strong, weak, and no-biofilm (Zero) producers, respectively. After thymol treatment, 26.25% and 73.75% of isolates were weak and no-producer (Zero) biofilms, respectively and there was a significant correlation (P-value = 0.042) compared to the control group. The frequency of fimH, sfa, and afa genes was 53.1%, 49.4%, and 29.4%, respectively. The expression of fimHgene after 48 h thymol treatment decreased significantly (P-value< 0.05). CONCLUSION Due to the significant effects of thymol in preventing the expression of the adhesion gene (fimH) of UPEC bacteria, our study is a proof-of-concept study evaluating bacterial sensitivity to Thymol and its effect on biofilm production in vitro. Given the demonstrated promising results of Thymol's effectiveness and the increase in bacterial antibiotic resistance, further studies should be undertaken to determine the safety and effectiveness of Thymol use in the clinical treatment of urinary tract infection. We believe that Thymol may prove to be an effective adjunct to the treatment of bacterial urinary tract infections.
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Affiliation(s)
- Rezvan Goodarzi
- Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rasoul Yousefimashouf
- Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Sedighi
- Department of Pediatrics, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Abbas Moradi
- Department of Community Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Department of Medical Microbiology, Faculty of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
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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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5
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Hewitt IK, Montini G, Marks SD. Vesico-ureteric reflux in children and young people undergoing kidney transplantation. Pediatr Nephrol 2023; 38:2987-2993. [PMID: 36279046 PMCID: PMC10432351 DOI: 10.1007/s00467-022-05761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/08/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
Vesico-ureteric reflux (VUR) into transplanted kidneys in children and young people is a common occurrence, found in 19 to 60% of those who had an anti-reflux procedure and up to 79% in the absence of such a procedure. While VUR is unlikely to be of concern without evidence of symptomatic urinary tract infections, less certainty exists regarding outcomes when the VUR is associated with urinary tract infection (UTI) and transplant pyelonephritis. Issues explored will include additional risk factors that might predispose to UTI, any effect of pyelonephritis on acute and long-term kidney allograft function and practical strategies that may reduce the prevalence of infection.
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Affiliation(s)
- Ian K Hewitt
- Perth Children's Hospital, Monash Avenue, Nedlands, WA, Australia
| | - Giovanni Montini
- Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, via della Commenda 9, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy.
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
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Jamil S, Zafar MN, Siddiqui S, Ayub S, Rizvi AUH. Recurrent Urinary Tract Infections in Renal Transplant Recipients: Risk Factors and Outcomes in Low-resource Settings. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2022; 33:761-773. [PMID: 38018718 DOI: 10.4103/1319-2442.390256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
Recurrent urinary tract infections (UTIs) after kidney transplantation are a common problem adversely affecting graft outcomes. This retrospective study aimed to report the frequency and risk factors of recurrent UTI and their impact on graft and patient outcomes in kidney transplant recipients at the Sindh Institute of Urology and Transplantation, Karachi, Pakistan, in January-December 2015. Five-year graft and patient survival rates were compared among different groups using Kaplan-Meier analysis. Of the 251 recipients, 67 developed one episode of UTI. Of these 67, 29 had 76 episodes of recurrent UTI. Out of the 76 episodes of recurrent UTI, Escherichia coli was the most common pathogen in 32 cases. Organisms causing recurrent UTI showed resistance to carbapenem in 19 cases versus 2 in the non-recurrent UTI group (P = 0.006). The estimated glomerular filtration rate at 1 year was 57.8 ± 16.23 mL/min/1.73 m2 in the recurrent UTI group vs. 61.9 ± 15.7 mL/min/1.73 m2 in the non-recurrent UTI group (P = 0.001). Graft survival in the recurrent UTI group at 5 years was significantly lower (76%) than in the non-recurrent UTI (95%) and no UTI groups (93%) (log-rank P = 0.006), with no significant effect on patient survival in these groups (P = 0.429). The presence of double-J stent (P = 0.036) and cytomegalovirus infections (P = 0.013) independently predicted recurrent UTI. Recurrent UTIs are common in low-resource settings and adversely affect graft outcomes. Appropriate prophylaxis and treatment are important to reduce recurrent UTI to improve graft outcomes.
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Affiliation(s)
- Sana Jamil
- Department of Microbiology, Sind Institute of Urology and Transplantation, Karachi, Pakistan
| | - Mirza Naqi Zafar
- Department of Pathology, Sind Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sulleha Siddiqui
- Department of Microbiology, Sind Institute of Urology and Transplantation, Karachi, Pakistan
| | - Salma Ayub
- Department of Chemical Pathology, Sind Institute of Urology and Transplantation, Karachi, Pakistan
| | - Adeeb-Ul-Hassan Rizvi
- Department of Urology, Sind Institute of Urology and Transplantation, Karachi, Pakistan
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The Prevalence and Risk Factors for Urinary Tract Infection in Kidney Transplant Recipients in the First Year After Transplantation. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-116629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: End-stage renal disease (ESRD) needs replacement therapy and most often, kidney transplantation is the best therapeutic option. Urinary tract infection (UTI) is one of the most important complications after renal transplantation that affects transplantation outcomes. Objectives: This study aimed to define the incidence rate, UTI risk factors among kidney transplant recipients, and causative organism of UTI and their antibiotic susceptibility. Methods: In this cross-sectional study, we collected clinical, demographic, and laboratory data from 268 transplant recipients in Ali-Asghar Hospital from 2011 - 2018. Data collected from patients were analyzed with SPSS software version 25. Results: According to the results, 50 (18.7%) had UTI in the first year after renal transplantation. Female gender and underlying cause of renal failure were predisposing factors for UTI. The most common causative organism was Escherichia coli (58.4%). The antibiotic susceptibility results showed nitrofurantoin and meropenem as the most effective antibiotics for Escherichia coli. Conclusions: The UTI was more common in women and patients with analgesic nephropathy and lupus nephritis. The most common causative organism was E. coli and meropenem and nitrofurantoin were the most effective drug choices.
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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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Jarasvaraparn C, Choudhury S, Rusch C, Nadler M, Liss KH, Stoll J, Hmiel S, Khan A, Doyle M, Kulkarni S. Characteristics, risk factors, and outcomes of neutropenia after liver or kidney transplantation in children. Pediatr Transplant 2022; 26:e14131. [PMID: 34494348 PMCID: PMC10591294 DOI: 10.1111/petr.14131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND While prior adult studies have shown that approximately 20%-38% of subjects undergoing solid-organ transplant develop neutropenia, similar analyses in pediatric subjects are scarce. METHODS We conducted a retrospective chart review of liver transplant (LT) and kidney transplant (KT) recipients at our center during the period 2008-2018. All of the KT and none of the LT subjects during this time period had induction with either anti-thymocyte globulin (ATG) or basiliximab at time of transplant. Neutropenia was defined as absolute neutrophil count (ANC) value ≤1000/mm3 . RESULTS One hundred subjects with LT and 82 subjects with KT were included. The incidence of neutropenia within the first year of transplant in KT was higher compared to LT (54.8% vs 39%, p = .01). The median number of hospitalizations (p = .001) and infectious complications (p = .04) was significantly higher only in the KT subjects who developed neutropenia (compared to those who did not). Multivariate analysis identified factors associated with severity of liver disease at transplant, namely h/o upper gastrointestinal bleeding (p = .02), weight deficit (p = .01), and pre-LT ANC (p = .01), along with high or moderate risk cytomegalovirus status (p = .05) as predictors of neutropenia in LT subjects. Female gender (p = .03) predicted neutropenia, while BK virus infection was protective for neutropenia (p = .04) in KT subjects. CONCLUSIONS The incidence of and morbidity associated with neutropenia within 1 year post-transplant is higher in KT subjects compared to LT subjects. The likely reason for this is the use of induction therapy (ATG, basiliximab) at the time of transplant in KT subjects.
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Affiliation(s)
- Chaowapong Jarasvaraparn
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Shelley Choudhury
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Courtney Rusch
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michelle Nadler
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kim H.H. Liss
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Janis Stoll
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stanley Hmiel
- Department of Pediatrics, Division of Nephrology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Adeel Khan
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Maria Doyle
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sakil Kulkarni
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Washington University School of Medicine, St. Louis, Missouri, USA
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A middle east systematic review and meta-analysis of bacterial urinary tract infection among renal transplant recipients; Causative microorganisms. Microb Pathog 2020; 148:104458. [PMID: 32835776 DOI: 10.1016/j.micpath.2020.104458] [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: 05/21/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
Abstract
UTI has been reported as the most prevalent infectious complication after-kidney transplantation. This study aimed to evaluate the bacterial urinary tract infection among renal transplant recipients, and causative microorganisms from the Middle East. We searched literatures reporting the prevalence of UTI, bacterial pathogens, and antibiotic resistance pattern from January 1, 2010-May 10, 2020 for patients with renal transplant recipients from the Middle East in international databases. Terms used were; "Urinary tract infection", "UTI", "bacterial pathogens", "bacterial infection", "renal transplant", "kidney transplant", post - renal transplant, "antibiotic resistance", "Middle East", Turkey, Iran, Jordan, Kuwait, Bahrain, Lebanon, United Arab Emirates, Qatar, Cyprus, Yemen, Iraq, Egypt, Palestine, and Syria. Data analyzed using CMA software. The prevalence of UTI among renal transplant recipients from the Middle East varied between 4.5 and 85%. The combined prevalence of UTI was reported by 37.9% (95% Cl: 28.3-48.5). The most prevalent organisms recovered from urine samples of patients with UTI were E. coli and Klebsiella with prevalence rate of 57.5%, and 15%, respectively. Also, Coagulase negative Staphylococcus (15%), and Enterococci (11.2%) were the most predominant among Gram positive microorganisms. The most resistance among Gram negative microorganisms belonged to Ceftazidime with frequency of 90% followed by Carbenicillin and Cephalexin with prevalence of 87.3%, and 84%, respectively. The effective antibiotic was Imipenem (15.2%). Regarding the high UTI rate in renal transplant recipients from the Middle East, and the significant presence of both Gram negative and Gram positive microorganisms as the most prevalent uropathogens after renal transplantation should be considered when selecting empirical antibacterial therapy.
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11
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Outcome Comparison between Low-Dose Rabbit Anti-Thymocyte Globulin and Basiliximab in Low-Risk Living Donor Kidney Transplantation. J Clin Med 2020; 9:jcm9051320. [PMID: 32370265 PMCID: PMC7290680 DOI: 10.3390/jcm9051320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/09/2023] Open
Abstract
The objective of this study was to compare outcomes between basiliximab and low-dose r-ATG in living donor kidney transplantation recipients with low immunological risk. Patients in the low-dose r-ATG group received 1.5 mg/kg of r-ATG for 3 days (total 4.5 mg/kg). Graft survival, patient survival, acute rejection, de novo donor specific antibody (DSA), estimated glomerular filtration rate (e-GFR) changes, and infection status were compared. Among 268 patients, 37 received r-ATG, and 231 received basiliximab. There was no noticeable difference in the graft failure rate (r-ATG vs. basiliximab: 2.7% vs. 4.8%) or rejection (51.4% vs. 45.9%). de novo DSA was more frequent in the r-ATG group (11.4% vs. 2.4%, p = 0.017). e-GFR changes did not differ noticeably between groups. Although most infections showed no noticeable differences between groups, more patients in the r-ATG group had cytomegalovirus (CMV) antigenemia and serum polyomavirus (BK virus) (73.0% vs. 51.9%, p = 0.032 in CMV; 37.8% vs. 15.6%, p = 0.002 in BK), which did not aggravate graft failure. Living donor kidney transplantation patients who received low-dose r-ATG and patients who received basiliximab showed comparable outcomes in terms of graft survival, function, and overall infections. Although CMV antigenemia, BK viremia were more frequent in the r-ATG group, those factors didn’t change the graft outcomes.
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12
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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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SHAPOURI MOGHADDAM A, ARFAATABAR M, TAVAKOL AFSHARI J, SHAKERIMOGHADDAM A, MOHAMMADZAMANI Z, KHALEDI A. Prevalence and Antimicrobial Resistance of Bacterial Uropathogens Isolated from Iranian Kidney Transplant Recipients: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:2165-2176. [PMID: 31993384 PMCID: PMC6974870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/11/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is a major complication in patients who receive the kidney transplant. We aimed to evaluate the prevalence and antimicrobial resistance of bacterial uropathogens isolated from Iranian kidney transplant recipients. METHODS We searched according to Prisma protocol for UTI infection, prevalence, occurrence and distribution of bacteria and their pattern of antibiotic resistance among Iranian patients who receive kidney transplant through online electronic databases with MeSh terms and text words in published references in both Persian and English languages during 1990-2017. Data analysis was performed using Comprehensive meta-analysis software (CMA) by Cochrane Q and I2 Random Effects Model. RESULTS Eleven studies met the eligible inclusion criteria. The prevalence of UTI among kidney transplant patients varied from 11.7% to 67.5%. The combined prevalence of UTI was 32.6%. Among Gram-negative pathogens causing UTI, E. coli was the most dominant followed by Klebsiella pneumonia with prevalence 41.3% and 11.9%, respectively. Also, amongst Gram-positive bacteria, the highest prevalence belonged to Enterococcus spp. (9.8%) and coagulase-negative Staphylococci (9.4%). Also in Gram-negative pathogens, the most resistance was to ampicillin (91.2%), followed by ceftazidime (89.5%). The minimum resistance was against imipenem with prevalence 14.3%. CONCLUSION The combined prevalence of UTI was 32.6%. Gram-negative pathogens especially E. coli were the most agents of UTI in Iranian patients who receive kidney transplant. Also, in gram-negative pathogens, the most resistance was to ampicillin that it needs a new strategy for prophylaxis and treatment of UTI after the kidney transplant.
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Affiliation(s)
- Abbas SHAPOURI MOGHADDAM
- Department of Immunology, BuAli Research Institute, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam ARFAATABAR
- Department of Medical Laboratory Sciences, Kashan Branch, Islamic Azad University, Kashan, Iran
| | - Jalil TAVAKOL AFSHARI
- Department of Immunology, BuAli Research Institute, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali SHAKERIMOGHADDAM
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra MOHAMMADZAMANI
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Azad KHALEDI
- Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran
- Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Tsai WT, Chang HC, Wang CT, Chiang BL, Lin YT. Long-term outcomes in lupus patients receiving different renal replacement therapy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:648-653. [DOI: 10.1016/j.jmii.2018.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 12/19/2018] [Accepted: 12/25/2018] [Indexed: 11/24/2022]
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15
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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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16
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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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17
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Hosseini SS, Ghaemi E, Koohsar F. Influence of ZnO nanoparticles on Candida albicans isolates biofilm formed on the urinary catheter. IRANIAN JOURNAL OF MICROBIOLOGY 2018; 10:424-432. [PMID: 30873271 PMCID: PMC6414736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to determine the effect of zinc oxide nanoparticle (ZnO-np) solution in the surface catheter on C. albicans adhesion and biofilm formation. MATERIALS AND METHODS Out of 260 isolates from urinary catheter, 133 were determined as C. albicans by common phenotypic and genotyping methods. ZnO nanoparticles with 30 nm were made by the sol-gel method, which was confirmed by XRD (X-ray diffraction) and scanning electron microscope (SEM) methods. Candidal adhesion and biofilm assays were performed on catheter surfaces for 2 and 48 hours, respectively. The effect of sub-MIC (minimum inhibitory concentrations) and MIC concentrations of ZnO-np on biofilm formation was evaluated after 24 hours using Crystal violet (CV), colony-forming unit (CFU), and SEM. RESULTS Out of 133 C. albicans isolates, 20 (15%) fluconazole-resistant and 113 (85%) susceptible isolates were determined by the disk diffusion method. Results showed that both isolates adhered to biofilm formation on the catheter surfaces. A significantly (P< 0.05) higher number of CFUs was evident in fluconazole-resistant biofilms compared to those formed by susceptible isolates. ZnO-np reduced biofilm biomass and CFUs of dual isolate biofilms (P< 0.05). ZnO nanoparticles had a significantly (P< 0.05) greater effect on reducing fluconazole-resistant C. albicans biofilm biomass compared to susceptible isolates. CONCLUSION Zno-np exhibits inhibitory effects on biofilms of both isolates. These findings provide an important advantage of ZnO that may be useful in the treatment of catheter-related urinary tract infection.
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Affiliation(s)
- Seyedeh Sedigheh Hosseini
- Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran,Department of Laboratory Sciences, Faculty of Paramedicine, Golestan University of Medical Sciences, Gorgan, Iran,Corresponding author: Seyedeh Sedigheh Hosseini, PhD, Laboratory Sciences Research Center, Golestan University of Medical Sciences, Gorgan, Iran; Department of Laboratory Sciences, Faculty of Paramedicine, Golestan University of Medical Sciences, Gorgan, Iran. Tel: +98-1732436105, Fax: +98-1732423630,
| | - Ezzatollah Ghaemi
- Department of Microbiology, Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran
| | - Faramarz Koohsar
- Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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18
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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: 13] [Impact Index Per Article: 2.2] [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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19
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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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20
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Abstract
BACKGROUND Yeasts are found in urine specimens relatively often, especially in the elderly and patients under treatment with broad spectrum antibiotics, i. e. especially in intensive care unit (ICU) patients. In some cases, the number of pathogens is very high, i. e. >105/ml. The clinical relevance of detecting Candida in urine is difficult to assess. In the German S3 guidelines it is apodictically stated that an ascending infection of the urinary tract by yeasts does not occur but this may undoubtedly happen in certain instances in patients at risk, for example in the elderly, in diabetic persons and in the case of foreign bodies in the urinary tract. A hematogenous spread of yeasts can lead to pyelonephritis, which accompanies candiduria. In rare cases this can be induced by prostatitis and epididymitis. Therapy is indicated in all cases when a urological manipulation is planned, particularly those with injury to the mucosal barrier, in order to prevent an intraoperative spread of pathogens. AIM The antimicrobial agents suitable for therapy of candiduria are limited, namely flucytosine, amphotericin B, which is also used for irrigation and fluconazole. MATERIAL AND METHODS The in vitro effect of nitroxoline on 100 isolates of yeasts from urine was tested by an agar diffusion test. RESULTS Nitroxoline exerted a good activity against all yeast isolates. DISCUSSION The antibiotic nitroxoline has a good antifungal activity. It achieves high concentrations in urine and in addition, it is effective at low pH as well as against pathogens in biofilms, which most antimycotics cannot achieve. Hence, nitroxoline is suitable for termination of candiduria. Foreign bodies in the urinary tract, on which biofilms are formed, should be removed whenever possible.
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Affiliation(s)
- H Hof
- MVZ Labor Dr. Limbach und Kollegen, Im Breitspiel 15, 69126, Heidelberg, Deutschland.
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21
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Reyes-Montes MDR, Duarte-Escalante E, Martínez-Herrera E, Acosta-Altamirano G, Frías-De León MG. Current status of the etiology of candidiasis in Mexico. Rev Iberoam Micol 2017; 34:203-210. [DOI: 10.1016/j.riam.2017.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 04/24/2017] [Accepted: 05/26/2017] [Indexed: 11/16/2022] Open
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22
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Sui W, Lipsky MJ, Matulay JT, Robins DJ, Onyeji IC, James MB, Theofanides MC, Wenske S. Timing and Predictors of Early Urologic and Infectious Complications After Renal Transplant: An Analysis of a New York Statewide Database. EXP CLIN TRANSPLANT 2017; 16:665-670. [PMID: 28697717 DOI: 10.6002/ect.2016.0357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The most common complications after renal transplant are urologic and are a cause of significant morbidity in a vulnerable population. We sought to characterize the timing and predictors of urologic complications after renal transplant using a statewide database. MATERIALS AND METHODS We queried the New York Statewide Planning and Research Cooperative System database to identify patients who underwent renal transplant from 2005 to 2013. Postoperative complications included hydronephrosis, ureteral stricture, vesicoureteral reflux, nephrolithiasis, and urinary tract infections. Cox proportional hazards model was used to assess independent predictors of urologic complications. RESULTS In total, 9038 patients were included in the analyses. Urologic complications occurred in 11.3% of patients and included hydronephrosis (12.0%), nephrolithiasis (2.8%), ureteral stricture (2.4%), and vesicoureteral reflux (1.5%). We found that 23% experienced at least one urinary tract infection. On multivariate analysis, predictors of urologic complications included medicare insurance, hypertension, and prior urinary tract infection. Graft recipients from living donors were less likely to experience urologic complications than deceased-donor kidney recipients (P < .001). CONCLUSIONS Urologic complications occur in a significant proportion of renal transplants. Further study is needed to identify risk factors for complications after renal transplantation to decrease morbidity in this vulnerable population.
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Affiliation(s)
- Wilson Sui
- From the Department of Urology, Columbia University Medical Center, New York, New York, USA
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23
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Goh YSB, Deng Z, Cheong PSC, Raman L, Goh THA, Vathsala A, Tiong HY. Screening for asymptomatic bacteruria at one month after adult kidney transplantation: Clinical factors and implications. Clin Transplant 2017; 31. [PMID: 28295630 DOI: 10.1111/ctr.12954] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Urinary tract infections (UTIs) account for significant morbidity after kidney transplantation (KT). Screening for asymptomatic bacteruria (AB) has proven to be beneficial in certain population including pregnant women; however, it is not well-studied in KT population. We reviewed the incidence, clinical features, and implications of asymptomatic bacteruria one month after KT. METHODS A total of 171 adult KT patients (86 [50.3%] living transplants, 87 [50.9%] males, mean age 47.3 ± 13.7 years), between 2005 and 2012, were analyzed. Immunosuppression induction and maintenance were as per protocol. Protocol urine cultures were taken at 1 month post-transplantation. Patients were stratified for presence of AB and analyzed for demographics and clinical parameters. Outcomes of hospitalization for symptomatic UTIs, graft, and patient survival were ascertained. RESULTS Forty-one (24%) KT recipients had AB at 30 days post-transplant. Multiresistant organisms accounted for 43.9% of these infections. Logistic regression confirms female sex and deceased donor recipients as independent predictors of 30-day bacteruria, which predicts subsequent hospitalization for symptomatic UTI. One-year patient and graft survival were similar in recipient with or without AB. CONCLUSION Asymptomatic bacteruria 30 days post-transplant can be predicted in female recipients and kidneys from deceased donors probably due to anatomical and functional differences respectively. There is increased morbidity of subsequent hospitalization for symptomatic UTI and more research in prevention of UTI is needed, particularly non-antibiotic prophylaxis.
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Affiliation(s)
| | - Zhaolong Deng
- Department of Urology, National University Hospital, Singapore city, Singapore
| | | | - Lata Raman
- Department of Urology, National University Hospital, Singapore city, Singapore
| | - Ting Hui Angeline Goh
- National University Centre for Organ Transplantation, National University Hospital, Singapore city, Singapore
| | - Anatharaman Vathsala
- National University Centre for Organ Transplantation, National University Hospital, Singapore city, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, Singapore city, Singapore.,National University Centre for Organ Transplantation, National University Hospital, Singapore city, Singapore
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24
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Solh T, Thomas R, Roman C. Current Diagnosis and Management of Urinary Tract Infections. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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Bissenova N, Yergaliyeva A. Microbiologic Monitoring of Patients Before and After Living-Donor Kidney Transplant. EXP CLIN TRANSPLANT 2016; 13 Suppl 3:91-2. [PMID: 26640923 DOI: 10.6002/ect.tdtd2015.p49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The aim of this study was to analyze microbiologic screening results of the respiratory tract and urine of patients before and after livingdonor kidney transplant. MATERIALS AND METHODS We analyzed the clinical screening results of 30 patients before and after living-donor kidney transplant who were treated in the Department of Transplantology at the National Scientific Medical Research Center from 2013 to 2014. Microbiologic screening results from urine, sputum, nasal, and throat tests were included: diagnostically significant concentration of isolates measured 105 colony-forming units/1 mL and above. Identification of isolates and antibiotic susceptibility testing were performed with the Vitek 2 Automated System (BioMerieux, 673 620 399 RCS LYON, 69280 Marcy I 'Etoile / France). RESULTS Results of routine microbiologic screening before living-donor kidney transplant showed that 29 of 30 patients had isolates at 105 colony-forming units /1 mL and above. In 10 patients (34.4%) isolates were obtained from throat swabs, with Streptococcus pneumoniae being the most frequent infection (37.9%). Results from nasal swabs showed Staphylococcus aureus (10.3%) and Staphylococcus epidermidis (17.2%). Sputum results showed that 15 patients had positive cultures (as monoculture in 11 patients and in microbial association in 4 patients). Bacteriuria was found in 4 patients. After transplant, only 6 patients showed isolates at infectious concentrations in microbiologic screening. CONCLUSIONS Microbiologic screening showed a decreased frequency of pathogenic and conditionally pathogenic isolates in patients after living-donor kidney transplant therefore, it is possible to significantly reduce septic complications.
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Affiliation(s)
- Nelya Bissenova
- From the Microbiology Laboratory, National Scientific Medial Research Center, Astana, Kazakhstan
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30
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Leylabadlo HE, Kafil HS, Yousefi M, Aghazadeh M, Asgharzadeh M. Persistent infection with metallo-beta-lactamase and extended spectrum β-lactamase producer Morganella morganii in a patient with urinary tract infection after kidney transplantation. J Nat Sci Biol Med 2016; 7:179-81. [PMID: 27433071 PMCID: PMC4934110 DOI: 10.4103/0976-9668.184707] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Organ transplant recipients under immunosuppressive therapy have a highly increased risk of acquiring unusual opportunistic infections. Diagnosis of the etiology of infection may be difficult in clinical manifestations, which need further histological and biological investigations. Here in we report, for the 1st time in the Iran, a Morganella morganii isolate harboring blaVIM, blaCTX-M, and blaSHV genes after kidney transplantation with persistent urinary infections.
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Affiliation(s)
| | - Hossein Samadi Kafil
- Drug Applied Research Center, Faculty of Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Aghazadeh
- Infectious Disease and Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asgharzadeh
- Biotechnology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Adamska Z, Karczewski M, Cichańska L, Więckowska B, Małkiewicz T, Mahadea D, Stronka M. Bacterial Infections in Renal Transplant Recipients. Transplant Proc 2016; 47:1808-12. [PMID: 26293055 DOI: 10.1016/j.transproceed.2015.03.046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/04/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients after kidney transplantation are highly susceptible to infections owing to immunosuppression as well as other risk factors--extended hospitalization, Foley catheterization, and double J catheter insertion among others. Bacterial infections, especially shortly after operation, are a major threat to the graft function. The aims of this study were to identify risk factors of bacterial infections after kidney transplantation and to determine the impact of those infections on the subsequent renal function. METHODS One hundred twenty patients who underwent kidney transplantation in 2013 and 2014 were examined in our study for possible risk factors of bacterial infections and for possible outcome of such infections on their future condition. RESULTS Among 120 patients under observation, 50 (41.7%) had early infectious complications (during hospitalization), 41 (82%) of which were urinary tract infections (UTI). The second most common infectious complication was infection of the surgical wound. Statistically significant results were obtained only for patient's age and duration of hospital stay (P = .001 and P = .000004, respectively). Bacterial infection resulted in longer hospital stay, higher reoperation risk, and lower creatinine clearance in the 14 days after transplantation (P = .000004, P = .0142, and P = .0455, respectively). CONCLUSION Bacterial infections influence mainly the short-term condition of kidney transplant recipients: extended hospital stay, decreased early creatinine clearance, and enhanced risk of reoperation. The most common risk factors, such as Foley catheterization, double J catheter insertion, and diabetes, were not significant in our observation.
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Affiliation(s)
- Z Adamska
- Department of Transplantology, General, Vascular and Plastic Surgery, Clinical Hospital of Poznan University of Medical Sciences, Poznan, Poland.
| | - M Karczewski
- Department of Transplantology, General, Vascular and Plastic Surgery, Clinical Hospital of Poznan University of Medical Sciences, Poznan, Poland
| | - L Cichańska
- Department of Transplantology, General, Vascular and Plastic Surgery, Clinical Hospital of Poznan University of Medical Sciences, Poznan, Poland
| | - B Więckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - T Małkiewicz
- Clinical Hospital of Poznan University of Medical Sciences, Poznan, Poland
| | - D Mahadea
- Clinical Hospital of Poznan University of Medical Sciences, Poznan, Poland
| | - M Stronka
- Department of Transplantology, General, Vascular and Plastic Surgery, Clinical Hospital of Poznan University of Medical Sciences, Poznan, Poland
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Pouladfar G, Jafarpour Z, Hosseini SAM, Janghorban P, Roozbeh J. Antibiotic selective pressure and development of bacterial resistance detected in bacteriuria following kidney transplantation. Transplant Proc 2016; 47:1131-5. [PMID: 26036537 DOI: 10.1016/j.transproceed.2014.11.062] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 11/13/2014] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Bacteriuria (symptomatic and asymptomatic) is the most common infectious complication after kidney transplantation. This study aimed to determine its prevalence among kidney transplant recipients hospitalized after transplantation, respective risk factors, and frequency of isolates and antibacterial susceptibility. METHODS Retrospectively, we divided hospitalized patients into 3 groups. Groups 1 and 2 included 78 and 152 recipients with and without bacteriuria, respectively, and the potential risk factors were compared. Cefixime was prescribed as early postsurgical prophylaxis. Group 3 patients were 116 randomly selected nontransplantation patients with urinary tract infection. Frequency of uropathogens and their antibiotic susceptibility were compared in groups 1 and 3. RESULTS In total, 103 bacteriuria episodes were detected in 15.2% of the patients. The frequency of risk factors in groups 1 and 2 was similar. Escherichia coli was the most common isolate in groups 1 (40.8%) and 3 (68.1%; P = .03). Streptococcus faecalis was the most common gram-positive isolate in groups 1 (17.5%) and 3 (6.9%; P = .03). Sensitivity rates in group 1 were 9% to trimethoprim-sulfamethoxazole, 20% to ciprofloxacin, and 38.4% to gentamicin, which was not significantly different from group 3. However, the sensitivity rates of gram-negative isolates to ceftriaxone were 9.5% and 28.4% (P = .004) in groups 1 and 3, respectively, and to cefixime 4.5% and 22% (P = .01). DISCUSSION High antibacterial resistance of uropathogens isolated from kidney transplantation and nontransplantation patients is alarming. The higher resistance to third-generation cephalosporins in transplant recipients may be due to antibiotic selection pressure secondary to postsurgical prophylaxis with cefixime.
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Affiliation(s)
- G Pouladfar
- Professor Alborzi Clinical Microbiology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Z Jafarpour
- Professor Alborzi Clinical Microbiology Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - S A M Hosseini
- Shiraz Transplant Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - P Janghorban
- Shiraz Transplant Research Center, Nemazee Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - J Roozbeh
- Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gondos AS, Al-Moyed KA, Al-Robasi ABA, Al-Shamahy HA, Alyousefi NA. Urinary Tract Infection among Renal Transplant Recipients in Yemen. PLoS One 2015; 10:e0144266. [PMID: 26657128 PMCID: PMC4675517 DOI: 10.1371/journal.pone.0144266] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/16/2015] [Indexed: 01/13/2023] Open
Abstract
Urinary tract infection (UTI) is the most common complication following kidney transplantation (KT), which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%). The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41-50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors.
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Affiliation(s)
- Adnan S. Gondos
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Sana'a University, Sana’a, Yemen
| | - Khaled A. Al-Moyed
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Sana'a University, Sana’a, Yemen
| | - Abdul Baki A. Al-Robasi
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Sana'a University, Sana’a, Yemen
| | - Hassan A. Al-Shamahy
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Sana'a University, Sana’a, Yemen
| | - Naelah A. Alyousefi
- Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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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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Vidal E, Cervera C, Cordero E, Armiñanzas C, Carratalá J, Cisneros JM, Fariñas MC, López-Medrano F, Moreno A, Muñoz P, Origüen J, Sabé N, Valerio M, Torre-Cisneros J. Management of urinary tract infection in solid organ transplant recipients: Consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2015; 33:679.e1-679.e21. [PMID: 25976754 DOI: 10.1016/j.eimc.2015.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common infections in solid organ transplant (SOT) recipients. METHODS Experienced SOT researchers and clinicians have developed and implemented this consensus document in support of the optimal management of these patients. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS Recommendations are provided on the management of asymptomatic bacteriuria, and prophylaxis and treatment of UTI in SOT recipients. The diagnostic-therapeutic management of recurrent UTI and the role of infection in kidney graft rejection or dysfunction are reviewed. Finally, recommendations on antimicrobials and immunosuppressant interactions are also included. CONCLUSIONS The latest scientific information on UTI in SOT is incorporated in this consensus document.
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Affiliation(s)
- Elisa Vidal
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Instituto Maimónides de Investigación en Biomedicina de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
| | - Carlos Cervera
- Servicio de Enfermedades Infecciosas, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Elisa Cordero
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - Carlos Armiñanzas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Jordi Carratalá
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, Barcelona, Spain
| | - José Miguel Cisneros
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - M Carmen Fariñas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Asunción Moreno
- Servicio de Enfermedades Infecciosas, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julia Origüen
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Núria Sabé
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, Barcelona, Spain
| | - Maricela Valerio
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julián Torre-Cisneros
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Instituto Maimónides de Investigación en Biomedicina de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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Araújo A, Santos F, Guimarães J, Nunes C, Casal M. Living-donor Kidney Transplantation: Predictive Factors and Impact on Post-transplant Outcome. Transplant Proc 2015; 47:938-41. [DOI: 10.1016/j.transproceed.2015.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wang Z, Vathsala A, Tiong HY. Haematuria in postrenal transplant patients. BIOMED RESEARCH INTERNATIONAL 2015; 2015:292034. [PMID: 25918706 PMCID: PMC4395992 DOI: 10.1155/2015/292034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 02/20/2015] [Accepted: 02/20/2015] [Indexed: 12/25/2022]
Abstract
Haematuria has a prevalence of 12% in the postrenal transplant patient population. It heralds potentially dangerous causes which could threaten graft loss. It is important to consider causes in light of the unique, urological, and immunological standpoints of these patients. We review the literature on common causes of haematuria in postrenal transplant patients and suggest the salient approach to the evaluation of this condition. A major cause of haematuria is urinary tract infections. There should be a higher index of suspicion for mycobacterial, fungal, and viral infection in this group of immunosuppressed patients. Measures recommended in the prevention of urinary tract infections include early removal of foreign bodies as well as prophylactic antibiotics during the early transplant phase. Another common cause of haematuria is that of malignancies, in particular, renal cell carcinomas. When surgically managing cancer in the setting of a renal transplant, one has to be mindful of the limited retropubic space and the need to protect the anastomoses. Other causes include graft rejections, recurrences of primary disease, and calculus formation. It is important to perform a comprehensive evaluation with the aid of an experienced multidisciplinary transplant team.
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Affiliation(s)
- Ziting Wang
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Anantharaman Vathsala
- Division of Nephrology, Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
| | - Ho Yee Tiong
- Department of Urology, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
- National University Centre for Organ Transplantation, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074
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Phillips H, Occhipinti LL, Aronson LR. Septicemia and Infection due to ESBL-producing K. pneumoniae Following Feline Renal Allograft Transplantation. J Am Anim Hosp Assoc 2015; 51:119-29. [PMID: 25695559 DOI: 10.5326/jaaha-ms-6103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 12 yr old castrated male domestic longhair underwent renal transplantation for treatment of chronic interstitial nephritis. Full-thickness intestinal biopsies obtained prior to transplantation revealed mild enteritis. Twelve months following transplantation, the patient underwent surgery for resection of a mesenteric mass causing septic peritonitis. The mesenteric mass was resected and an intestinal resection and anastomosis was performed. Extended-spectrum-β-lactamase producing Klebsiella pneumoniae was cultured from the resected tissue and urinary tract. Bacterial rods were noted to be circulating in the bloodstream, causing septicemia. Despite aggressive treatment of the septic peritonitis and septicemia using surgical debridement, drain placement, aggressive antibiotic therapy with IV meropenem, and vasopressor support, the patient succumbed to persistent hypotension and suffered cardiopulmonary arrest. Extended-spectrum-β-lactamase-producing bacteria are of growing concern in human and veterinary medicine, maintaining susceptibility often only to carbapenem and aminoglycoside antibiotics. Resistance to even those antibiotics is emerging. Veterinary patients with a history of antibiotic therapy, central venous or urinary catheterization, immunosuppression, enteric surgery, and an extended stay in the intensive care unit may be predisposed.
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Affiliation(s)
- Heidi Phillips
- From the University of Illinois, Urbana, IL (H.P.); Veterinary Specialists of Rochester, Rochester, New York (L.O.); and University of Pennsylvania, Philadelphia, PA (L.A.)
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Becknell B, Schober M, Korbel L, Spencer JD. The diagnosis, evaluation and treatment of acute and recurrent pediatric urinary tract infections. Expert Rev Anti Infect Ther 2014; 13:81-90. [PMID: 25421102 DOI: 10.1586/14787210.2015.986097] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Urinary tract infection (UTI) is one of the most common bacterial infections encountered by pediatricians. Currently, the diagnosis and management of acute UTI and recurrent UTI in children remain controversial. Recently published guidelines and large clinical trials have attempted to clarify UTI diagnostic and management strategies. In this manuscript, we review the diagnosis and management of acute and recurrent UTI in the pediatric population.
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Affiliation(s)
- Brian Becknell
- Department of Pediatrics, Division of Nephrology, Nationwide Children's Hospital, Columbus, OH, USA
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Infections with blaKPC-2-producing Klebsiella pneumoniae in renal transplant patients: a retrospective study. Transplant Proc 2014; 45:3389-93. [PMID: 24182822 DOI: 10.1016/j.transproceed.2013.07.064] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 07/04/2013] [Accepted: 07/24/2013] [Indexed: 01/14/2023]
Abstract
In renal transplant recipients, the urinary tract is the most common site of infections that might be caused by pathogens while on immunosuppressive therapy. The spread of enterobacteria resistant to carbapenem is worrying, as it is generally used as this agent is the first-line therapy for infections caused by Enterobacteriaceae producing extended spectrum β-lactamases. The most frequently encountered class A carbapenemases are the Klebsiella pneumoniae carbapenemase (KPC) enzymes. We describe the treatment and outcomes of 6 renal transplant patients who had urinary tract infections (UTIs) with blaKPC-2-producing K pneumoniae, confirmed by polymerase chain reaction amplification, namely 13.33% of renal transplant patients in the study period. Four patients survived, including 1 with reinfections and relapse, and 2 patients died. The antibiotics used for treatment, alone or combined, were colistin (n = 6, 42.8%), tigecycline (n = 5, 35.7%), doxycycline (n = 3, 21.4%), meropenem (n = 3, 21.4%), and fosfomycyn (n = 1, 7%). UTIs caused by carbapenemase-producing K pneumoniae are life-threatening. In the cases presented, favorable results were achieved with monotherapies using colistin, doxycycline, or meropenem.
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Khosravi AD, Abasi Montazeri E, Ghorbani A, Parhizgari N. Bacterial urinary tract infection in renal transplant recipients and their antibiotic resistance pattern: A four-year study. IRANIAN JOURNAL OF MICROBIOLOGY 2014; 6:74-8. [PMID: 25705355 PMCID: PMC4281663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary tract infections (UTIs) are the most common infections in renal transplant recipients and are considered a potential cause of bacteremia, sepsis, and affects graft outcomes. The aim of the present study was to determine the incidence of UTI among renal transplant recipients and investigation of antimicrobial susceptibility pattern of causative agents. MATERIALS AND METHODS In total, 1165 patients from March 2009 to December 2012, in transplant center of Golestan Hospital, Ahvaz, Iran, were investigated. Qualitative urine cultures were performed for all cases, causative microorganisms were identified and colony count was performed according to the standard protocol. Antibiotic susceptibility testing was then performed to determine the susceptibility pattern of recovered bacteria from confirmed UTIs. RESULTS UTI was diagnosed in 391 patients(33.56%). Gram-negative bacteria were the most prevalent isolated microorganisms with E. coli (43.53%), followed by Enterobacter spp. (35.37%) as the major organisms. Among Gram positives, Coagulase-negative Staphylococci was isolated from 6.8% of cases. The rate of resistance to all tested antibiotics was highest in Enterobacter spp., however the most common resistance were seen against cefixime, cephalotin, and cotrimoxazole in all tested gram negatives. CONCLUSION the rate of UTIs among renal transplant recipients was noticeable in this study with high antibiotic resistance. Multi-resistant bacterial infections are potentially life-threatening emerging problem in renal transplantation. Prophylactic measures must be applied to patients at greater risk.
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Affiliation(s)
- Azar Dokht Khosravi
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Effat Abasi Montazeri
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ali Ghorbani
- Internal Medicine Ward, Golestan Teaching hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Najmeh Parhizgari
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Medicinal Plants Research Center, Yasuj University of Medical Sciences, Yasuj, Iran
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Corrêa APA, Brahm MMT, Teixeira CDC, Ferreira SAL, Manfro RC, Lucena ADF, Echer IC. [Complications during the hospitalization of kidney transplant recipients]. Rev Gaucha Enferm 2013; 34:46-54. [PMID: 24344584 DOI: 10.1590/s1983-14472013000300006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of the study was to identify the complications in patients that have received a renal transplant. A Historical cohort performed in a university hospital from January/2007 through January/2009 with a sample of 179 patients; data collected retrospectively from the medical history of patients and submitted to statistical analyses. Mean age of patients was 43 (SD=13.7) years, 114 (63.7%) men, 95 (65.1%) non smokers and 118(66.93%) received the graft from a deceased donor. The main complications were rejection 68 (32.1%) and infection 62 (29.2%). There was statistical significance between rejection and median days of hospital stay (p < 0.001); days of use of central venous catheter (p = 0.010) and smoking status (p = 0.008); infection and central venous catheter (p = 0.029); median days of hospital stay (p < 0.001) and time of use of urinary catheter (p = 0.009). It was concluded that it is important to reduce the days of hospital stay and permanence of catheters, which may be considered in the planning of nursing care.
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Bucheli E, Kralidis G, Boggian K, Cusini A, Garzoni C, Manuel O, Meylan PRA, Mueller NJ, Khanna N, van Delden C, Berger C, Koller MT, Weisser M. Impact of enterococcal colonization and infection in solid organ transplantation recipients from the Swiss transplant cohort study. Transpl Infect Dis 2013; 16:26-36. [PMID: 24330137 DOI: 10.1111/tid.12168] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/14/2013] [Accepted: 05/14/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of enterococcal infections has increased over the last decades with vancomycin-resistant enterococci (VRE) being a major health problem. Solid organ transplantation is considered as a risk factor. However, little is known about the relevance of enterococci in solid organ transplantation recipients in areas with a low VRE prevalence. METHODS We examined the epidemiology of enterococcal events in patients followed in the Swiss Transplant Cohort Study between May 2008 and September 2011 and analyzed risk factors for infection, aminopenicillin resistance, treatment, and outcome. RESULTS Of the 1234 patients, 255 (20.7%) suffered from 392 enterococcal events (185 [47.2%] infections, 205 [52.3%] colonizations, and 2 events with missing clinical information). Only 2 isolates were VRE. The highest infection rates were found early after liver transplantation (0.24/person-year) consisting in 58.6% of Enterococcus faecium. The highest colonization rates were documented in lung transplant recipients (0.33/person-year), with 46.5% E. faecium. Age, prophylaxis with a betalactam antibiotic, and liver transplantation were significantly associated with infection. Previous antibiotic treatment, intensive care unit stay, and lung transplantation were associated with aminopenicillin resistance. Only 4/205 (2%) colonization events led to an infection. Adequate treatment did not affect microbiological clearance rates. Overall mortality was 8%; no deaths were attributable to enterococcal events. CONCLUSIONS Enterococcal colonizations and infections are frequent in transplant recipients. Progression from colonization to infection is rare. Therefore, antibiotic treatment should be used restrictively in colonization. No increased mortality because of enterococcal infection was noted.
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Affiliation(s)
- E Bucheli
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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Tsai MT, Yeh JT, Yang WC, Wu TH. CAPD-related peritonitis caused by Morganella morganii. Perit Dial Int 2013; 33:104-5. [PMID: 23349203 DOI: 10.3747/pdi.2012.00035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Osawa K, Shigemura K, Yoshida H, Fujisawa M, Arakawa S. Candida urinary tract infection and Candida species susceptibilities to antifungal agents. J Antibiot (Tokyo) 2013; 66:651-4. [PMID: 23801184 DOI: 10.1038/ja.2013.68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 05/20/2013] [Accepted: 05/29/2013] [Indexed: 11/09/2022]
Abstract
The purpose of this study is to review Candida isolation from urine of urinary tract infection (UTI) patients over the recent 3 years at the Kobe University Hospital. We recorded the type of strain, the department where the patient was treated such as the intensive care unit (ICU), and combined isolation of Candida with other microorganisms. We investigated Candida isolation and susceptibilities to antifungal agents and analyzed the risk factors for combined isolation with other microorganisms. The most frequently isolated Candida was Candida albicans, which showed good (100%) susceptibilities to 5-fluorocytosine (5-FC) and fluconazole (FLCZ) but not to voriconazole (VRCZ), followed by C. glabrata. ICU was the greatest source of Candida-positive samples, and the most relevant underlying diseases of ICU patients were pneumonia followed by renal failure and post liver transplantation status. Combined isolation with other bacteria was seen in 27 cases (42.9%) in 2009, 25 (33.3%) in 2010 and 31 (31.3%) in 2011 and comparatively often seen in non-ICU patients. Other candidas than C. albicans showed significantly decreased susceptibility to FLCZ over these 3 years (P=0.004). One hundred (97.1%) of 103 ICU cases were given antibiotics at the time of Candida isolation, and the most often used antibiotics were cefazolin or meropenem. In conclusion, C. albicans was representatively isolated in Candida UTI and showed good susceptibilities to 5-FC, FLCZ and VRCZ, but other candidas than C. albicans showed significantly decreased susceptibility to FLCZ in the change of these 3 years.
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Affiliation(s)
- Kayo Osawa
- Infectious control team, Kobe University Hospital, Kobe, Japan
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Primary Percutaneous Treatment of Transplant Ureteral Strictures Using Tandem Stents. J Vasc Interv Radiol 2013; 24:874-80. [DOI: 10.1016/j.jvir.2013.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 02/11/2013] [Accepted: 02/16/2013] [Indexed: 11/20/2022] Open
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Urinary Tract Infection and Kidney Transplantation: A Review of Diagnosis, Causes, and Current Clinical Approach. Transplant Proc 2013; 45:1590-2. [DOI: 10.1016/j.transproceed.2013.01.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 01/15/2013] [Indexed: 11/23/2022]
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Chordia P, Schain D, Kayler L. Effects of ureteral stents on risk of bacteriuria in renal allograft recipients. Transpl Infect Dis 2013; 15:268-75. [DOI: 10.1111/tid.12062] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 05/24/2012] [Accepted: 10/02/2012] [Indexed: 12/31/2022]
Affiliation(s)
- P. Chordia
- Department of Infectious Disease; Detroit Medical Center; Detroit; Michigan; USA
| | - D. Schain
- Department of Infectious Disease; University of Florida; Gainesville; Florida; USA
| | - L. Kayler
- Department of Surgery; Montefiore Medical Center; Bronx; New York; USA
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Intestinal Enterobacteriaceae and Escherichia coli populations in Japanese adults demonstrated by the reverse transcription-quantitative PCR and the clone library analyses. J Microbiol Methods 2012; 92:213-9. [PMID: 23262033 DOI: 10.1016/j.mimet.2012.12.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 12/08/2012] [Accepted: 12/09/2012] [Indexed: 01/15/2023]
Abstract
A primer set specific for Escherichia coli/Shigella 16S rRNA was developed and used for RT-qPCR analysis of fecal samples from 35 healthy adult volunteers in combination with the previously reported primer set specific for Enterobacteriaceae. Enterobacteriaceae and E. coli were present in the 29 out of 35 volunteers tested as intestinal commensals at the average population levels of 10(7.1±0.9) and 10(6.8±0.7)cellsg(-1) of stools (mean±standard deviation), respectively. Among the 7 volunteers, the significant deviation between the count of Enterobacteriaceae and that of E. coli was observed, suggesting non-E. coli/Shigella species were predominant in their Enterobacteriaceae populations. The clone library analysis revealed that the non-E. coli/Shigella populations included Citrobacter freundii, Citrobacter koseri, Enterobacter cloacae, Klebsiella oxytoca, Klebsiella pneumoniae/variicola and Morganella morganii. These data suggested that the RT-qPCR method with the primer sets specific to both Enterobacteriaceae and E. coli/Shigella enabled the accurate enumeration of intestinal E. coli populations and the other Enterobacteriaceae species populations.
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