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[Renal transplantation and urinary infection. Review]
F J Burgos Revilla1, J Pascual Santos, R Marcén Letosa
1Servicio de Urología, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid.
Abstract:
Urinary infection (UTI) is the most frequent infection after renal transplantation (RT). The literature shows and incidence between 10-98%. The risk of associated bacteraemia is close to 12%. Gram- bacteria are the most frequent causal agents (70%), although gram+, mainly enterococcus and staphylococcus, candida and some other exotic germs such as Corynebacterium are also potential etiological agents. Certain factors present in the receptor during pre-RT, RT itself and post-RT condition the development and evolution of UTIs. Clinical signs and symptoms are multiple ranging from asymptomatic bacteriuria to graft's abscess or septic shock. Incidence in females (54%) is higher than in males (29%). Immunosuppressive regimes based on Cyclosporin (35%) show lower incidence of UTI than those based in Azathioprine (50%). Antibiotic prophylaxis with Co-trimoxazol reduces incidence of UTIs at post-RT and delays the time of appearance of the first UTI episode.
Insights
Urinary tract infections (UTIs) are common after renal transplantation (RT), with varying causes and symptoms. Co-trimoxazole prophylaxis can reduce UTI incidence and delay onset post-RT.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Context:
- Urinary tract infections (UTIs) represent the most frequent infectious complication following renal transplantation (RT).
- Literature reports a wide incidence range of 10-98% for UTIs post-RT.
- The risk of associated bacteremia is approximately 12%.
Purpose:
- To review the epidemiology, etiology, risk factors, clinical presentation, and management of UTIs in renal transplant recipients.
- To highlight the impact of immunosuppressive regimens and prophylactic strategies on UTI development.
Summary:
- Gram-negative bacteria are the primary causative agents (70%), with Gram-positive bacteria, Candida, and other organisms also implicated.
- UTI presentation ranges from asymptomatic bacteriuria to severe complications like graft abscess or septic shock.
- Female recipients exhibit a higher incidence (54%) compared to males (29%).
Impact:
- Cyclosporine-based immunosuppression is associated with a lower UTI incidence (35%) than Azathioprine-based regimens (50%).
- Antibiotic prophylaxis with Co-trimoxazole effectively reduces post-RT UTI incidence and delays the first episode.
- Understanding these factors is crucial for optimizing patient care and outcomes after renal transplantation.