Sharifian M, Rees L, Trompeter R S
Great Ormond Street Hospital for Children NHS Trust, London, UK.
Nephrol Dial Transplant. 1998 Feb;13(2):432-5. doi: 10.1093/oxfordjournals.ndt.a027842.
Bacteriuria is common post-transplant. However, most studies are in adults with a short follow-up. We have assessed the incidence of bacteriuria, predisposing causes and its effect on short and long-term graft function in children.
The notes of 142 children (67% male) who received 168 kidney transplants (138 cadaveric) between 1987 and 1994 were studied. The mean age at transplantation was 9.0 +/- 4.5 years, and 32 children were transplanted pre-emptively. Diagnoses reflected those found in any children's renal failure programme.
Two hundred and thirty one episodes of bacteriuria were detected in 66 patients patients (46%): a rate of one episode per 23 patient months of follow-up. Fifty two percent were during the first year, and 29% of these during the first 4 weeks post-transplant. Forty two children (28%) had recurrences. The incidence was not affected by sex, vesico-ureteric reflux into native kidneys, donor source, circumcision in boys, dialysis pre-transplant or acute rejection. Bacteriuria was significantly more common in patients with a history of bacteriuria before transplant (P < 0.005) and with bladder pathology (P < 0.001). Organisms were predominantly coliforms (41%); 70% were Gram-negative. Sixty percent were resistant to the prescribed antibiotic prophylaxis. There was an associated transient rise in plasma creatinine concentration: mean pre-episode 111 +/- 86 mumol/l vs mean post-episode 134 +/- 108 mumol/l (P < 0.0001). Seventy two percent of episodes were asymptomatic, but even in this group 81% had an associated rise in plasma creatinine (P < 0.001). Despite this, there was no significant decrease in glomerular filtration rate in patients with bacteriuria compared with patients without at the end of follow-up: 50 vs 56 ml/min/1.73 m2 respectively.
Bacteriuria is common post-transplant, occurring most often in those with bladder pathology or with a history of bacteriuria pre-transplant.
移植后菌尿症很常见。然而，大多数研究针对的是随访期短的成年人。我们评估了儿童菌尿症的发生率、诱发因素及其对移植肾短期和长期功能的影响。
研究了1987年至1994年间接受168例肾移植（138例尸体肾移植）的142名儿童（67%为男性）的病历。移植时的平均年龄为9.0±4.5岁，32名儿童接受了抢先移植。诊断反映了任何儿童肾衰竭项目中的情况。
在66例患者（46%）中检测到231次菌尿发作：随访期间每23个患者月发作一次。52%发生在第一年，其中29%发生在移植后前4周。42名儿童（28%）复发。发病率不受性别、原生肾膀胱输尿管反流、供体来源、男孩包皮环切术、移植前透析或急性排斥反应的影响。移植前有菌尿病史的患者（P<0.005）和有膀胱病变的患者（P<0.001）中菌尿症明显更常见。病原体主要是大肠埃希菌（41%）；70%为革兰阴性菌。60%对规定的抗生素预防耐药。血浆肌酐浓度有相关的短暂升高：发作前平均为111±86μmol/L，发作后平均为134±108μmol/L（P<0.0001）。72%的发作是无症状的，但即使在这组患者中，81%的患者血浆肌酐也有升高（P<0.001）。尽管如此，随访结束时，有菌尿症的患者与无菌尿症的患者相比，肾小球滤过率没有显著下降：分别为50和56ml/min/1.73m²。
移植后菌尿症很常见，最常发生在有膀胱病变或移植前有菌尿病史的患者中。
