Strohaeker Jens, Aschke Victoria, Koenigsrainer Alfred, Nadalin Silvio, Bachmann Robert
Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany.
J Clin Med. 2021 Dec 31;11(1):226. doi: 10.3390/jcm11010226.
(1) Background: Urinary tract infections (UTI) are the most common infections after kidney transplantation. Given the risk of urosepsis and the potential threat to the graft, the threshold for treating UTI and asymptomatic bacteriuria with broad spectrum antibiotics is low. Historically fluoroquinolones were prescription favorites for patients that underwent kidney transplantation (KT). After the recent recommendation to avoid them in these patients, however, alternative treatment strategies need to be investigated (2) Methods: We retrospectively analyzed the charts of 207 consecutive adult kidney transplantations that were performed at the department of General, Visceral and Transplantation Surgery of the University Hospital of Tuebingen between January 2015 and August 2020. All charts were screened for the diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infections (UTI) and the patients' clinical characteristics and outcomes were evaluated. (3) Results: Of the 207 patients, 68 patients suffered from urinary tract infections. Patients who developed UTI had worse graft function at discharge ( = 0.024) and at the 12 months follow-up ( < 0.001). The most commonly prescribed antibiotics were Ciprofloxacin and Piperacillin/Tazobactam. To both, bacterial resistance was more common in the study cohort than in the control group. (4) Conclusions: Urinary tract infections appear to be linked to worse graft functions. Thus, prevention and treatment should be accompanied by antibiotic stewardship teams.
(1) 背景：尿路感染（UTI）是肾移植后最常见的感染。鉴于存在尿脓毒症风险以及对移植肾的潜在威胁，使用广谱抗生素治疗UTI和无症状菌尿的阈值较低。从历史上看，氟喹诺酮类药物是肾移植（KT）患者的首选处方药。然而，在最近建议避免在这些患者中使用此类药物后，需要研究替代治疗策略。(2) 方法：我们回顾性分析了2015年1月至2020年8月在图宾根大学医院普通、内脏和移植外科进行的207例连续成人肾移植患者的病历。筛查所有病历以了解无症状菌尿（ASB）和尿路感染（UTI）的诊断和治疗情况，并评估患者的临床特征和结局。(3) 结果：在207例患者中，68例患有尿路感染。发生UTI的患者出院时（P = 0.024）和12个月随访时（P < 0.001）的移植肾功能较差。最常开具的抗生素是环丙沙星和哌拉西林/他唑巴坦。在研究队列中，这两种抗生素的耐药情况均比对照组更常见。(4) 结论：尿路感染似乎与较差的移植肾功能有关。因此，预防和治疗应在抗生素管理团队的参与下进行。
