Alevizakos Michail, Nasioudis Dimitrios, Mylonakis Eleftherios
Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Rhode Island, RI, USA.
Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
Transpl Infect Dis. 2017 Dec;19(6). doi: 10.1111/tid.12759. Epub 2017 Oct 24.
Urinary tract infections (UTIs) are the most common infectious complications among renal transplant recipients (RTR). UTIs caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) have been associated with inferior clinical outcomes and increased financial burden.
We performed a systematic review and meta-analysis by searching through the PubMed and EMBASE databases (to May 20, 2016) and identifying studies that reported data on the number of RTR who developed an ESBL-PE UTI.
Our analysis included seven studies, out of 357 non-duplicate articles, that provided data on 2824 patients. Among them, 10% (95% confidence interval [CI] 4%-17%) developed an ESBL-PE UTI over their follow-up periods. The proportion of RTR affected by an ESBL-PE UTI was 2% in North America (95% CI 1%-3%), 5% in Europe (95% CI 4%-6%), 17% in South America (95% CI 10%-27%), and 33% in Asia (95% CI 27%-41%). In addition, patients affected with an ESBL-PE UTI were 2.75-times (95% CI 1.97-3.83) more likely to suffer a recurrent UTI.
Based on a limited number of studies, one in 10 RTR will develop a UTI caused by an ESBL-PE, and these patients face an almost 3 times greater risk of recurrence. A more rigorous monitoring of RTR, both during and after resolution of their infection, should be evaluated in order to reduce the incidence and the clinical impact of these resistant infections.
尿路感染（UTIs）是肾移植受者（RTR）中最常见的感染性并发症。由产超广谱β-内酰胺酶（ESBL）的肠杆菌科细菌（ESBL-PE）引起的尿路感染与较差的临床结局及增加的经济负担相关。
我们通过检索PubMed和EMBASE数据库（截至2016年5月20日）进行了一项系统评价和荟萃分析，并识别报告了发生ESBL-PE尿路感染的RTR数量数据的研究。
我们的分析纳入了357篇非重复文章中的7项研究，这些研究提供了2824例患者的数据。其中，10%（95%置信区间[CI] 4%-17%）在随访期间发生了ESBL-PE尿路感染。北美受ESBL-PE尿路感染影响的RTR比例为2%（95% CI 1%-3%），欧洲为5%（95% CI 4%-6%），南美为17%（95% CI 10%-27%），亚洲为33%（95% CI 27%-41%）。此外，发生ESBL-PE尿路感染的患者复发性尿路感染的可能性高2.75倍（95% CI 1.97-3.83）。
基于有限数量的研究，每10名RTR中有1名将发生由ESBL-PE引起的尿路感染，且这些患者复发风险几乎高3倍。为降低这些耐药感染的发生率和临床影响，应评估在感染解决期间及之后对RTR进行更严格监测的情况。
