Gołębiewska J, Dębska-Ślizień A, Komarnicka J, Samet A, Rutkowski B
Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Transplant Proc. 2011 Oct;43(8):2985-90. doi: 10.1016/j.transproceed.2011.07.010.
Urinary tract infections (UTIs) are most common infections in renal transplant recipients and are considered a potential risk factor for poorer graft outcomes.
To evaluate incidence, clinical manifestations, microbiology, risk factors for UTIs, and the influence of UTIs on long-term renal graft function.
We analyzed urine cultures with reference to clinical data of patients who received a renal transplantation from January to December 2009 with a 12-month follow-up.
The 1170 urine cultures were correlated with clinical data from 89 renal transplant recipients, including 58.4% males and on overall mean age of 48±14 years. The 151 episodes in 49 patients consisted of asymptomatic bacteriuria (65%, n=98); lower UTIs (13%, n=19); and upper UTIs (22%, n=34), as well as five cases of bacteremia. Nearly 48% of UTIs were diagnosed during the first month posttransplantation. The most frequently isolated uropathogens were Enterococcus faecium (33%, n=24) and Escherichia coli (31%, n=23). Beginning from the second month, most frequently found bacterium in urine cultures was E coli (65% n=51). Risk factors for posttransplant UTIs were female gender and a history of an acute rejection episode and/or a cytomegalovirus (CMV) infection. All patients with vesicoureteral reflux of strictures at the ureterovesical junction suffered recurrent UTIs (n=7). The evolution of renal graft function did not differ significantly between patients with versus without UTIs.
UTIs a frequent problem after kidney transplantation most commonly exist as asymptomatic bacteriuria. E coli and E faecium are ther predominant pathogens. Exposure to intensified immunosuppression due to acute rejection episodes or CMV infections represents a risk factor for UTIs. Vesicoureteral reflux or strictures at the ureterovesical junction are risk factors for recurrent UTIs. UTIs did not impair 1-year graft function.
尿路感染（UTIs）是肾移植受者中最常见的感染，被认为是移植肾预后较差的一个潜在危险因素。
评估尿路感染的发病率、临床表现、微生物学、危险因素以及尿路感染对移植肾长期功能的影响。
我们参考了2009年1月至12月接受肾移植患者的临床资料，并对其尿液培养结果进行了分析，随访时间为12个月。
1170份尿液培养结果与89例肾移植受者的临床资料相关，其中男性占58.4%，总体平均年龄为48±14岁。49例患者发生的151次感染包括无症状菌尿（65%，n = 98）；下尿路感染（13%，n = 19）；上尿路感染（22%，n = 34），以及5例菌血症。近48%的尿路感染在移植后第一个月被诊断出来。最常分离出的尿路病原体是粪肠球菌（33%，n = 24）和大肠杆菌（31%，n = 23）。从第二个月开始，尿液培养中最常发现的细菌是大肠杆菌（65%，n = 51）。移植后尿路感染的危险因素是女性性别、急性排斥反应发作史和/或巨细胞病毒（CMV）感染。所有输尿管膀胱连接处有狭窄或膀胱输尿管反流的患者均反复发生尿路感染（n = 7）。有尿路感染和无尿路感染患者的移植肾功能演变无显著差异。
尿路感染是肾移植后常见的问题，最常见的形式是无症状菌尿。大肠杆菌和粪肠球菌是主要病原体。急性排斥反应发作或CMV感染导致的强化免疫抑制是尿路感染的危险因素。膀胱输尿管反流或输尿管膀胱连接处狭窄是反复发生尿路感染的危险因素。尿路感染并未损害移植肾1年的功能。
