Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.
Department of Nephrology, Transplantation, Dialysis and Apheresis, Pellegrin University Hospital, Bordeaux.
Curr Opin Infect Dis. 2020 Dec;33(6):419-425. doi: 10.1097/QCO.0000000000000678.
Urinary tract infection (UTI) is the most common infection in kidney transplant recipients (KTRs). Several elements increase the risk of UTI and/or modify its clinical presentation among KTRs (e.g. immunosuppressive therapy, kidney allograft denervation, and use of urinary catheters). Also, KTRs may have UTIs because of difficult-to-identify and/or difficult-to-treat organisms. We provide an overview of the current knowledge regarding bacterial UTIs in KTRs, with a focus on recent findings.
There is accumulating evidence from clinical trials that screening for and treating asymptomatic bacteriuria is not beneficial in most KTRs (i.e. those who are ≥1-2 months posttransplant and do not have a urinary catheter). These patients have a point-prevalence of asymptomatic bacteriuria of only 3% and treating asymptomatic bacteriuria probably does not improve their outcomes. There is no clinical trial evidence to guide the management of symptomatic UTI in KTRs. Several important clinical questions remain unanswered, especially regarding the management of posttransplant pyelonephritis and the prevention of UTI in KTRs.
Despite its frequency and associated morbidity, UTI after kidney transplantation is an understudied infection. In an era of increasing antimicrobial resistance and limited resources, further research is needed to ensure optimal use of antimicrobials in KTRs with UTI.
尿路感染（UTI）是肾移植受者（KTR）中最常见的感染。一些因素会增加 KTR 发生 UTI 的风险和/或改变其临床特征（例如免疫抑制治疗、肾移植去神经支配和使用导尿管）。此外，KTR 可能因难以识别和/或难以治疗的病原体而发生 UTI。我们概述了当前关于 KTR 细菌 UTI 的知识，重点介绍了最近的发现。
越来越多的临床试验证据表明，在大多数 KTR 中（即移植后≥1-2 个月且无导尿管的患者），筛查和治疗无症状菌尿并没有益处。这些患者无症状菌尿的时点患病率仅为 3%，治疗无症状菌尿可能不会改善其预后。目前没有临床试验证据指导 KTR 症状性 UTI 的管理。仍有一些重要的临床问题尚未得到解答，特别是关于移植后肾盂肾炎的管理和 KTR 中 UTI 的预防。
尽管尿路感染在肾移植后很常见且相关发病率较高，但它仍是一个研究不足的感染。在抗菌药物耐药性不断增加和资源有限的时代，需要进一步研究以确保在 KTR 中有 UTI 时合理使用抗菌药物。
