Department of Microbiology, Sind Institute of Urology and Transplantation, Karachi, Pakistan.
Department of Pathology, Sind Institute of Urology and Transplantation, Karachi, Pakistan.
Saudi J Kidney Dis Transpl. 2022 Nov 1;33(6):761-773. doi: 10.4103/1319-2442.390256. Epub 2023 Nov 29.
Recurrent urinary tract infections (UTIs) after kidney transplantation are a common problem adversely affecting graft outcomes. This retrospective study aimed to report the frequency and risk factors of recurrent UTI and their impact on graft and patient outcomes in kidney transplant recipients at the Sindh Institute of Urology and Transplantation, Karachi, Pakistan, in January-December 2015. Five-year graft and patient survival rates were compared among different groups using Kaplan-Meier analysis. Of the 251 recipients, 67 developed one episode of UTI. Of these 67, 29 had 76 episodes of recurrent UTI. Out of the 76 episodes of recurrent UTI, Escherichia coli was the most common pathogen in 32 cases. Organisms causing recurrent UTI showed resistance to carbapenem in 19 cases versus 2 in the non-recurrent UTI group (P = 0.006). The estimated glomerular filtration rate at 1 year was 57.8 ± 16.23 mL/min/1.73 m2 in the recurrent UTI group vs. 61.9 ± 15.7 mL/min/1.73 m2 in the non-recurrent UTI group (P = 0.001). Graft survival in the recurrent UTI group at 5 years was significantly lower (76%) than in the non-recurrent UTI (95%) and no UTI groups (93%) (log-rank P = 0.006), with no significant effect on patient survival in these groups (P = 0.429). The presence of double-J stent (P = 0.036) and cytomegalovirus infections (P = 0.013) independently predicted recurrent UTI. Recurrent UTIs are common in low-resource settings and adversely affect graft outcomes. Appropriate prophylaxis and treatment are important to reduce recurrent UTI to improve graft outcomes.
肾移植后复发性尿路感染（UTI）是影响移植物预后的常见问题。本回顾性研究旨在报告 2015 年 1 月至 12 月在巴基斯坦卡拉奇 Sindh 泌尿科和移植研究所肾移植受者中复发性 UTI 的频率、危险因素及其对移植物和患者预后的影响。不同组间比较使用 Kaplan-Meier 分析比较 5 年移植物和患者生存率。251 例受者中，67 例发生 1 次 UTI 发作。其中 67 例中有 29 例发生 76 次复发性 UTI。在 76 次复发性 UTI 中，大肠埃希菌是最常见的病原体，有 32 例。与非复发性 UTI 组的 2 例相比，复发性 UTI 组的病原体对碳青霉烯类药物的耐药性为 19 例（P = 0.006）。复发性 UTI 组在 1 年时的估计肾小球滤过率为 57.8 ± 16.23 mL/min/1.73 m2，而非复发性 UTI 组为 61.9 ± 15.7 mL/min/1.73 m2（P = 0.001）。复发性 UTI 组 5 年时的移植物存活率（76%）明显低于非复发性 UTI（95%）和无 UTI 组（93%）（对数秩检验 P = 013），但对这些组的患者存活率无显著影响（P = 0.429）。双 J 支架（P = 0.036）和巨细胞病毒感染（P = 0.013）的存在独立预测复发性 UTI。复发性 UTI 在资源匮乏的环境中很常见，会对移植物预后产生不利影响。适当的预防和治疗对于减少复发性 UTI 以改善移植物预后非常重要。
