Sarier M, Seyman D, Tekin S, Duman I, Uygun B, Demir M, Kukul E, Yavuz A H
Department of Urology, Kemerburgaz University, Istanbul, Turkey.
Department of Infectious Disease and Clinical Microbiology, Antalya Education and Research Hospital, Antalya, Turkey.
Transplant Proc. 2017 Nov;49(9):2082-2085. doi: 10.1016/j.transproceed.2017.09.028.
The use of a ureteral stent can cause a urinary tract infection (UTI), although it reduces urologic complications. UTIs are associated with a higher rate of ureteral stent colonization (USC). The aim of this study was to compare USC in living and deceased donor renal transplant recipients.
We conducted a prospective study of 48 patients who underwent renal transplantation between January and December 2016. The stents were removed aseptically, the inner surface of proximal and distal ends of stents were irrigated with liquid culture medium, and then they were vortexed for bacteriological investigation. Urine cultures were taken at the same time.
A total of 45 renal transplantation patients (21 from cadavers, 24 from live donors) were evaluated in the study. The duration time of stent retention in patients with live donors was 25.04 ± 4.55 and in patients with deceased donors was 26.19 ± 4.08 days (P = .376). USC was observed in 12 (57.1%) and 6 (25%) patients while positive urine culture (PUC) was detected in 5 (23.8%) and 2 (8.3%) patients in deceased and live donor transplant recipients, respectively. Although the USC rate was significantly higher in the deceased donor renal transplant group (P = .022), there was no significant different in the rates of PUC (P = .137). Enterecoccus species was the common pathogen isolated from ureteral stent and urine. The micro-organisms isolated from ureteral stent in deceased and live donors, respectively, were distributed as follows: Enterococcus 5/3, Candida 3/1, Escherichia coli 2/1, Klebsiella pneumonia 1/1, and staphylococci in 1/0 patients. All E coli and K pneumoniae are extended spectrum beta-lactamase (ESBL)-positive isolates and resistant to sulfamethoxazole-trimethoprim (SMX/TMP).
We report a high incidence of USC in deceased renal transplants. Enterecoccus instead of E coli is the most common pathogen during the first month after transplantation. Transplantation centers should be aware that deceased donor renal transplant recipients are more prone to stent-related infection and the antibacterial resistance rapidly increases in uropathogens.
输尿管支架的使用虽能减少泌尿系统并发症，但可引发尿路感染（UTI）。UTI与输尿管支架定植（USC）率较高相关。本研究旨在比较活体和 deceased 供体肾移植受者的 USC情况。
我们对2016年1月至12月间接受肾移植的48例患者进行了一项前瞻性研究。无菌取出支架，用液体培养基冲洗支架近端和远端的内表面，然后进行涡旋以进行细菌学检查。同时采集尿液培养样本。
本研究共评估了45例肾移植患者（21例来自尸体供体，24例来自活体供体）。活体供体患者的支架留置时间为25.04±4.55天，尸体供体患者为26.19±4.08天（P = 0.376）。尸体供体和活体供体移植受者中分别有12例（57.1%）和6例（25%）患者观察到USC，而分别有5例（23.8%）和2例（8.3%）患者检测到阳性尿培养（PUC）。尽管尸体供体肾移植组的USC率显著更高（P = 0.022），但PUC率无显著差异（P = 0.137）。肠球菌是从输尿管支架和尿液中分离出的常见病原体。尸体供体和活体供体中从输尿管支架分离出的微生物分布如下：肠球菌5/3、念珠菌3/1、大肠杆菌2/1、肺炎克雷伯菌1/1，以及葡萄球菌在1/0例患者中。所有大肠杆菌和肺炎克雷伯菌均为超广谱β-内酰胺酶（ESBL）阳性菌株，且对磺胺甲恶唑-甲氧苄啶（SMX/TMP）耐药。
我们报告尸体肾移植中USC的发生率较高。移植后第一个月内，肠球菌而非大肠杆菌是最常见的病原体。移植中心应意识到尸体供体肾移植受者更容易发生与支架相关的感染，且尿路病原体的抗菌耐药性迅速增加。
