Mohan M V N L R, Neeraja M, Sudhaharan S, Raju S B, Gangadhar T, Lakshmi V
Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Department of Nephrology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India.
Indian J Nephrol. 2017 Sep-Oct;27(5):372-376. doi: 10.4103/ijn.IJN_331_16.
Renal transplantation is an effective and commonly performed procedure for end-stage renal disease. Urinary tract infections are a major cause of morbidity and mortality in renal transplant patients. As data on postrenal transplant urinary tract infections from the Indian subcontinent are limited, the present study was conducted to estimate the burden of urinary tract infections in this vulnerable group of patients. This was a prospective study on patients undergoing renal transplantation in 2014 at our tertiary hospital in South India with a follow-up of 2 years to evaluate the risk factors for urinary tract infections. The prevalence of urinary tract infections was 41.9% with a male preponderance of 76.9%. Mean age of the 31 patients was 32.4 ± 10.2 years (range: 16-55 years). Gram-negative bacilli were the most common isolates with being the predominant pathogen (53.3%). All the infections occurred within 1 year of transplantation with delayed graft function ( < 0.001; confidence interval [CI]: 29.0-96.3) and prolonged hospital stay ( = 0.0281; CI: 42.1-99.6) being the significant risk factors for acquiring urinary tract infections. Carbapenemase production was noted in 33.3% of isolates and all the Gram-negative organisms isolated in the 1 month of transplantation were carbapenem-resistant (CR) . The high rate of carbapenem-resistant organisms in the early posttransplant period is a point of concern, especially with cadaver transplants. Infection control practices and catheter care need to be strictly monitored to minimize the risk for UTI in the immediate posttransplant period.
肾移植是治疗终末期肾病的一种有效且常用的方法。尿路感染是肾移植患者发病和死亡的主要原因。由于来自印度次大陆的肾移植后尿路感染数据有限,本研究旨在评估这一弱势群体中尿路感染的负担。这是一项对2014年在印度南部我们的三级医院接受肾移植患者的前瞻性研究,随访2年以评估尿路感染的危险因素。尿路感染的患病率为41.9%,男性占优势,为76.9%。31例患者的平均年龄为32.4±10.2岁(范围:16 - 55岁)。革兰氏阴性杆菌是最常见的分离菌株, 是主要病原体(53.3%)。所有感染均发生在移植后1年内,移植肾功能延迟(<0.001;置信区间[CI]:29.0 - 96.3)和住院时间延长(=0.0281;CI:42.1 - 99.6)是发生尿路感染的重要危险因素。33.3%的分离菌株检测到碳青霉烯酶产生,移植后1个月内分离出的所有革兰氏阴性菌均对碳青霉烯类耐药(CR)。移植后早期碳青霉烯类耐药菌的高发生率令人担忧,尤其是尸体肾移植。需要严格监测感染控制措施和导管护理,以尽量降低移植后即刻发生尿路感染的风险。