Ramadas Poornima, Rajendran Prejith P, Krishnan Prathik, Alex Asha, Siskind Eric, Kadiyala Aditya, Jayaschandran Vivek, Basu Amit, Bhaskaran Madhu, Molmenti Ernesto P
Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
Department of Surgery, North Shore University Hospital, Manhasset, New York, United States of America.
PLoS One. 2014 Mar 17;9(3):e91289. doi: 10.1371/journal.pone.0091289. eCollection 2014.
Urinary tract infection (UTI) is a well-recognized early complication in renal transplant recipients (RTR) and can have significant bearing on their outcome. The recent rise in incidence of extended spectrum beta lactamase (ESBL) producing bacteria causing UTI among RTR poses new and significant challenges in terms of management and outcome. Our aim is to analyze the effect of ESBL producing bacteria causing UTI in these patients and its impact on allograft function.
We reviewed the medical records of 147 RTR who were followed at a tertiary care hospital affiliated transplant center between January 2007 and May 2013 and noted five RTR who developed episodes of ESBL producing bacteria related UTI during follow up. Multiple patient characteristics including demographics, immunosuppression, recurrences, allograft function and outcome were analyzed.
Five patients (3.4%) out of 147 had ESBL producing bacteria related UTI. We found all patients to be above 60 years of age, with three out of five being females, and all five patients had diabetes mellitus. We identified a total of 37 episodes of UTI among these five patients during this period. Two of these patients had elevated creatinine values during the episodes of UTI and three of them developed bacteremia. Of the five patients, four of them had a favorable outcome except for one patient who developed persistent allograft dysfunction.
RTR are at a higher risk for developing ESBL producing bacteria associated UTI. Early diagnosis along with appropriate and judicious use of antibiotics will ensure long term success in allograft and patient outcome.
尿路感染（UTI）是肾移植受者（RTR）中一种公认的早期并发症，对其预后有重大影响。近年来，在RTR中由产超广谱β-内酰胺酶（ESBL）细菌引起的UTI发病率上升，在管理和预后方面带来了新的重大挑战。我们的目的是分析产ESBL细菌引起这些患者UTI的影响及其对移植肾功能的影响。
我们回顾了2007年1月至2013年5月在一家三级医疗医院附属移植中心随访的147例RTR的病历，发现5例RTR在随访期间发生了产ESBL细菌相关的UTI。分析了包括人口统计学、免疫抑制、复发、移植肾功能和预后等多个患者特征。
147例患者中有5例（3.4%）发生了产ESBL细菌相关的UTI。我们发现所有患者年龄均超过60岁，5例中有3例为女性，且所有5例患者均患有糖尿病。在此期间，这5例患者共发生了37次UTI。其中2例患者在UTI发作期间肌酐值升高，3例发生了菌血症。5例患者中，除1例发生持续性移植肾功能不全外，其余4例预后良好。
RTR发生产ESBL细菌相关UTI的风险较高。早期诊断以及合理、明智地使用抗生素将确保移植肾和患者预后的长期成功。
