Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan.
Saudi J Kidney Dis Transpl. 2020 Sep-Oct;31(5):905-916. doi: 10.4103/1319-2442.301197.
Urinary tract infection (UTI) is the most common infectious disease in post-kidney transplantation patients. The objective of the study was to investigate the prevalence, impact and risk factors of multiple drug resistant (MDR) UTI in kidney transplant recipients. This retrospective cohort study recruited 72 kidney transplant recipients between March 2017 and February 2018. Urine cultures performed during the 1 year of posttransplantation with reference to clinical data were evaluated. Predesigned questionnaire was used to collect data regarding demographic, transplant related, and microbiological information. Multivariate analysis was performed to ascertain risk factors of MDR UTI. Out of 72 patients, 28 (38.9%) had culture guided clinical UTI. Overall, 59 UTI episodes were noted throughout the duration of this study. Eschericia coli were found to be the most frequent uropathogen of UTI among kidney transplant recipients (n = 32, 54.2%). MDR bacteria were responsible for 27.1% (n = 16) of the post-transplantation UTI episodes among patients, with E. coli (n = 9, 56.3%) being the predominant bacterial pathogen. Most of the MDR strains of E. coli (n = 7, 77.8%) were extended spectrum beta-lactamase positive. Female gender (P <0.001), prolonged Foley's catheterization (P = 0.002), coexisting diabetes mellitus (DM) (P <0.001) and induction of anti-thymocyte globulin (ATG) therapy (P <0.001) were independently associated with high risk of MDR UTI. The allograft rejection was found to be significantly higher in patients of posttransplantation UTI with MDR uropathogen (P = 0.009). In conclusion, E. coli were the most prominent uropathogen of UTI with and without MDR pathogen in the present study. Female gender, prolonged Foley's catheterization, coexisting DM, and induction of ATG therapy were the risk factors independently associated with MDR UTI in kidney transplant recipients. MDR organisms were significantly associated with allograft rejection.
尿路感染（UTI）是肾移植后患者最常见的传染病。本研究的目的是调查肾移植受者中多重耐药（MDR）UTI 的流行率、影响和危险因素。这项回顾性队列研究招募了 2017 年 3 月至 2018 年 2 月期间的 72 名肾移植受者。对移植后 1 年内进行的尿液培养，并参考临床数据进行了评估。使用预先设计的问卷收集有关人口统计学、移植相关和微生物学信息的数据。进行多变量分析以确定 MDR UTI 的危险因素。在 72 名患者中，28 名（38.9%）有培养指导的临床 UTI。总的来说，在整个研究过程中，共发现 59 例 UTI 发作。在肾移植受者中，大肠埃希菌是最常见的尿路感染病原体（n=32，54.2%）。在移植后 UTI 患者中，MDR 细菌占 27.1%（n=16），其中大肠埃希菌（n=9，56.3%）是主要的细菌病原体。大多数大肠埃希菌的 MDR 株（n=7，77.8%）对扩展型β-内酰胺酶呈阳性。女性（P<0.001）、延长 Foley 导尿管留置时间（P=0.002）、并存糖尿病（DM）（P<0.001）和使用抗胸腺细胞球蛋白（ATG）治疗（P<0.001）与 MDR UTI 的高风险独立相关。在发生 MDR 病原体尿路感染的移植后患者中，同种异体移植排斥反应明显更高（P=0.009）。总之，在本研究中，大肠埃希菌是引起 UTI 及有无 MDR 病原体的最主要病原体。女性、延长 Foley 导尿管留置时间、并存 DM 和诱导 ATG 治疗是肾移植受者中与 MDR UTI 独立相关的危险因素。MDR 病原体与同种异体移植排斥反应显著相关。
