1 Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. 2 Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. 3 Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California-Davis, Davis, CA. 4 The Rogosin Institute, New York, NY. 5 Transplantation-Oncology Infectious Diseases Program, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. 6 Division of Transplant Surgery, Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. 7 Address correspondence to: Thangamani Muthukumar, M.D., Division of Nephrology and Hypertension, Department of Medicine, and Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, 525 East 68th Street, Box 3, New York, NY.
Transplantation. 2013 Oct 27;96(8):732-8. doi: 10.1097/TP.0b013e3182a04997.
Urinary tract infection (UTI) is a frequent, serious complication in kidney allograft recipients.
We reviewed the records of 1166 kidney allograft recipients who received their allografts at our institution between January 2005 and December 2010 and determined the incidence of UTI during the first 3 months after transplantation (early UTI). We used Cox proportional hazards models to determine the risk factors for early UTI and whether early UTI was an independent risk factor for subsequent bacteremia or acute cellular rejection (ACR).
UTI, defined as 10 or more bacterial colony-forming units/mL urine, developed in 247 (21%) of the 1166 recipients. Independent risk factors for the first episode of UTI were female gender (hazard ratio [HR], 2.9; 95% confidence intervals [CI], 2.2-3.7; P<0.001), prolonged use of Foley catheter (HR, 3.9; 95% CI, 2.8-5.4; P <0.001), ureteral stent (HR, 1.4; 95% CI, 1.1-1.8; P=0.01), age (HR, 1.1; 95% CI, 1.0-1.2; P=0.03), and delayed graft function (HR, 1.4; 95% CI, 1.0-1.9; P=0.06). Trimethoprim/sulfamethoxazole prophylaxis was associated with a reduced risk of UTI (HR, 0.6; 95% CI, 0.3-0.9; P=0.02). UTI was an independent risk factor for subsequent bacteremia (HR, 2.4; 95% CI, 1.2-4.8; P=0.01). Untreated UTI, but not treated UTI, was associated with an increased risk of ACR (HR, 2.8; 95% CI, 1.3-6.2; P=0.01).
Female gender, prolonged use of Foley catheter, ureteral stent, age, and delayed graft function are independent risk factors for early UTI. UTI is independently associated with the development of bacteremia, and untreated UTI is associated with subsequent ACR.
尿路感染（UTI）是肾移植受者常见且严重的并发症。
我们回顾了 2005 年 1 月至 2010 年 12 月期间在我们机构接受肾移植的 1166 例肾移植受者的记录，并确定了移植后前 3 个月（早期 UTI）发生 UTI 的发生率。我们使用 Cox 比例风险模型确定早期 UTI 的危险因素，以及早期 UTI 是否是随后发生菌血症或急性细胞排斥反应（ACR）的独立危险因素。
1166 例受者中，247 例（21%）发生 UTI，定义为尿液中细菌菌落形成单位≥10 个/ml。UTI 首发的独立危险因素包括女性（风险比[HR]，2.9；95%置信区间[CI]，2.2-3.7；P<0.001）、 Foley 导管长期使用（HR，3.9；95%CI，2.8-5.4；P<0.001）、输尿管支架（HR，1.4；95%CI，1.1-1.8；P=0.01）、年龄（HR，1.1；95%CI，1.0-1.2；P=0.03）和延迟移植物功能（HR，1.4；95%CI，1.0-1.9；P=0.06）。甲氧苄啶/磺胺甲噁唑预防可降低 UTI 风险（HR，0.6；95%CI，0.3-0.9；P=0.02）。UTI 是随后发生菌血症的独立危险因素（HR，2.4；95%CI，1.2-4.8；P=0.01）。未经治疗的 UTI 而不是经治疗的 UTI 与 ACR 风险增加相关（HR，2.8；95%CI，1.3-6.2；P=0.01）。
女性、Foley 导管长期使用、输尿管支架、年龄和延迟移植物功能是早期 UTI 的独立危险因素。UTI 与菌血症的发生独立相关，未经治疗的 UTI 与随后的 ACR 相关。
