Kawecki D, Kwiatkowski A, Sawicka-Grzelak A, Durlik M, Paczek L, Chmura A, Mlynarczyk G, Rowinski W, Luczak M
Department of Medical Microbiology, Medical University of Warsaw, Warsaw, Poland.
Transplant Proc. 2011 Oct;43(8):2991-3. doi: 10.1016/j.transproceed.2011.09.002.
Urinary tract infection (UTI) is among the most common infections in solid organ transplantation, especially in kidney transplantation.
This study included 295 adult patients undergoing KTx between September 2001 and December 2007. All patients were followed prospectively for UTI during the first 4 weeks after surgery. Samples of urine were investigated by bacteriological cultures to identify microorganisms in accord with standard procedures. Susceptibility testing was performed using Clinical and Laboratory Standards Institute procedures.
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%) predominantly Serratia marcescens (32.3%) and Enterobacter cloacae (14.6%). Extended- spectrum beta-lactamase (ESBL+) strains were isolated in 52.5% of cases. Gram-positive bacteria comprised 35.7%; most commonly, high-level aminoglycoside resistant (HLAR; 87.8%) and vancomycin-resistant (VRE; 11%) Enterococci. There were fungal strains in 23 cases (7.9%).
Our study showed predominantly Gram-negative rods from the Enterobacteriaceae family comprising (84.8%) of Gram-negative isolates: 52.5% ESBL and resistant enterococci (87.5%) in Gram-positive isolates. The increased proportion of isolates of multi-drug-resistant bacterial agents which can cause severe UTIs may be due to our frequent use of ceftriaxone for perioperative bacterial prophylaxis.
尿路感染（UTI）是实体器官移植中最常见的感染之一，尤其是在肾移植中。
本研究纳入了2001年9月至2007年12月期间接受肾移植的295例成年患者。所有患者在术后前4周接受UTI的前瞻性随访。按照标准程序通过细菌培养对尿液样本进行研究，以鉴定微生物。使用临床和实验室标准协会的程序进行药敏试验。
在移植后的第一个月，从245例受者中的84.5%获取了尿液标本（n = 582）。在分离出的细菌菌株（n = 291）中，最常见的是革兰氏阴性菌（56.4%），主要是粘质沙雷氏菌（32.3%）和阴沟肠杆菌（14.6%）。52.5%的病例分离出超广谱β-内酰胺酶（ESBL+）菌株。革兰氏阳性菌占35.7%；最常见的是高水平氨基糖苷类耐药（HLAR；87.8%）和耐万古霉素（VRE；11%）的肠球菌。有23例（7.9%）真菌菌株。
我们的研究表明，革兰氏阴性菌主要为肠杆菌科的杆菌，占革兰氏阴性分离株的84.8%：52.5%为ESBL，革兰氏阳性分离株中耐抗生素肠球菌占87.5%。可导致严重UTI的多重耐药细菌菌株分离比例增加可能是由于我们围手术期频繁使用头孢曲松进行细菌预防。
