Valera B, Gentil M A, Cabello V, Fijo J, Cordero E, Cisneros J M
Servicio de Enfermedades Infecciosas, Hospitales Universitarios Virgen del Rocío, Seville, Spain.
Transplant Proc. 2006 Oct;38(8):2414-5. doi: 10.1016/j.transproceed.2006.08.018.
Urinary tract infection (UTI) remains a significant cause of infectious complications in renal transplant recipients. We evaluated prospectively all the UTIs in 161 kidney recipients transplanted between July 2003 and July 2005. All patients received prophylaxis with sulfadoxine-pyrimethamine. We excluded asymptomatic bacteriuria. Forty-one patients (25%) suffered at least one UTI episode. Ninety-two episodes of infection were confirmed with an incidence rate of 97 UTI episodes per 100 patient-years. The most common clinical features were uncomplicated acute bacterial cystitis, 71 episodes (77%), and acute pyelonephritis, 21 episodes (23%). Microbiological isolation was confirmed in 58 episodes (63%). Bacterial infections were the most frequent etiologies: gram-negative bacilli in 52 (90%), gram-positive cocci in 4 (7%), fungal in 2 (3%), and one viral BK virus (2%) infection. The causative microorganisms were E. coli as the principal isolated agent in 41 cases (71%), including 10 (24%) that were extended-spectrum betalactamases (ESBLEC). All episodes showed a favorable course. The survival rate of the graft at the end of the study period was 90.7%, and the survival rate of the transplant recipients was 97.5%. The incidence of UTI in transplant patients who received antibiotic prophylaxis was high. E. coli (ESBLEC) was the main agent isolated. Uncomplicated UTI, the most frequent post transplantation infection, showed a good prognosis.
尿路感染（UTI）仍然是肾移植受者感染性并发症的一个重要原因。我们对2003年7月至2005年7月期间接受移植的161例肾移植受者的所有UTI进行了前瞻性评估。所有患者均接受了磺胺多辛-乙胺嘧啶预防治疗。我们排除了无症状菌尿症。41例患者（25%）至少发生过一次UTI发作。共确诊92次感染发作，发病率为每100患者年97次UTI发作。最常见的临床特征为单纯性急性细菌性膀胱炎，71次发作（77%），以及急性肾盂肾炎，21次发作（23%）。58次发作（63%）确诊有微生物分离。细菌感染是最常见的病因：革兰氏阴性杆菌52例（90%），革兰氏阳性球菌4例（7%），真菌2例（3%），以及1例病毒性BK病毒感染（2%）。致病微生物以大肠杆菌为主，共分离出41例（71%），其中10例（24%）为超广谱β-内酰胺酶（ESBLEC）。所有发作均呈良好病程。研究期末移植物存活率为90.7%，移植受者存活率为97.5%。接受抗生素预防的移植患者UTI发病率较高。大肠杆菌（ESBLEC）是主要分离病原体。单纯性UTI是移植后最常见的感染，预后良好。
