Britt Nicholas S, Hagopian Jennifer C, Brennan Daniel C, Pottebaum April A, Santos Carlos A Q, Gharabagi Ara, Horwedel Timothy A
Department of Pharmacy, Barnes-Jewish Hospital, St Louis, MO, USA.
Department of Medicine, Division of Nephrology, Washington University School of Medicine, St Louis, MO, USA.
Nephrol Dial Transplant. 2017 Oct 1;32(10):1758-1766. doi: 10.1093/ndt/gfx237.
Urinary tract infections (UTIs) are common following kidney transplantation (KT); however, the influence of recurrent post-KT UTI (R-UTI) is not well-characterized.
We compared graft outcomes, patient outcomes and multidrug-resistance rates between patients with no UTI, nonrecurrent UTI (NR-UTI) (urine sample containing >105 bacterial colony-forming units/mL) and R-UTI (≥2 UTIs in any 6-month period or ≥3 UTIs in any 12-month period) post-KT in a retrospective cohort study (1999-2014) at Barnes-Jewish Hospital (St Louis, MO). All adult KT recipients were included and those experiencing mortality within 30 days of KT were excluded.
Of 2469 recipients included, 1835 (74.3%) had no UTI, 465 (18.8%) had NR-UTI and 169 (6.8%) had R-UTI. R-UTI was associated with poorer graft survival compared with NR-UTI [hazard ratio (HR) 1.45; 95% confidence interval (CI) 1.23-1.83; P < 0.001) and no UTI (HR 2.11; 95% CI 2.02-3.80; P < 0.001). This relationship persisted after adjusting for confounding factors in Cox regression (HR 2.01; 95% CI 1.53-2.66; P < 0.001). There was no difference in patient survival between no UTI and NR-UTI (HR 1.21; 95% CI 0.91-1.63; P = 0.181); however, R-UTI was associated with poorer patient survival compared with nonrecurrent cases (HR 1.87; 95% CI 1.21-2.89; P = 0.005). R-UTI were more likely to be caused by multidrug-resistant Gram-negative organisms (risk ratio 1.49; 95% CI 1.31-1.70; P < 0.001).
R-UTIs were associated with poorer graft and patient outcomes, as well as increased multidrug-resistance compared with nonrecurrent cases.
肾移植（KT）后尿路感染（UTI）很常见；然而，肾移植后复发性尿路感染（R-UTI）的影响尚未得到充分描述。
在巴恩斯犹太医院（密苏里州圣路易斯）进行的一项回顾性队列研究（1999 - 2014年）中，我们比较了肾移植后无尿路感染、非复发性尿路感染（NR-UTI）（尿样中细菌菌落形成单位/mL>105）和复发性尿路感染（R-UTI）（在任何6个月期间≥2次UTI或在任何12个月期间≥3次UTI）患者的移植结局、患者结局和多重耐药率。纳入了所有成年肾移植受者，排除了肾移植后30天内死亡的患者。
在纳入的2469名受者中，1835名（74.3%）无尿路感染，465名（18.8%）有非复发性尿路感染，169名（6.8%）有复发性尿路感染。与非复发性尿路感染相比，复发性尿路感染与较差的移植存活率相关[风险比（HR）1.45；95%置信区间（CI）1.23 - 1.83；P<0.001]，与无尿路感染相比也是如此（HR 2.11；95% CI 2.02 - 3.80；P<0.001）。在Cox回归中调整混杂因素后，这种关系仍然存在（HR 2.01；95% CI 1.53 - 2.66；P<0.001）。无尿路感染和非复发性尿路感染患者的生存率没有差异（HR 1.21；95% CI 0.91 - 1.63；P = 0.181）；然而，与非复发性病例相比，复发性尿路感染与较差的患者生存率相关（HR 1.87；95% CI 1.21 - 2.89；P = 0.005）。复发性尿路感染更可能由多重耐药革兰氏阴性菌引起（风险比1.49；95% CI 1.31 - 1.70；P<0.001）。
与非复发性病例相比，复发性尿路感染与较差的移植和患者结局以及增加的多重耐药性相关。
