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[Urinary tract infections during the 1st month after kidney transplantation]
Abstract:
The incidence and the predisposal factors of urinary tract infections (UTI) in the first month post-transplant were studied in 255 kidney transplantations (252 patients). UTI episodes were demonstrated in 73.7% of the grafts. The most common organisms were: Escherichia coli (35.8%), Staphylococcus (33.6%), Streptococcus D (11.2%), Klebsiella (5.3%). The infectious episodes were recurrent in 39% of the cases. The majority of the UTIs were asymptomatic but 7% of the infections led to septicaemia. Etiology of end-stage renal disease, pre-graft binephrectomy, asymptomatic vesicoureteral reflux into the patient's own kidneys, type of immunosuppressive treatment, acute tubular necrosis, rejection episodes, urological complications, coexistent other infections were not predisposal factors. Bacteriuria was more frequent in female than in male patients. The incidence of UTI was found to be statistically increased with history of UTI preoperatively (p = 0.039) and the use of ureteral catheter (p = 0.018). Occurrence of UTI was less common when the donor was treated by antibiotics before brain death (p-0.025). These results provide additional support for regular monitoring of urine cultures in the first month post-transplant. They should help to identify means of reduction of this infectious risk.
Insights
Urinary tract infections (UTIs) affect over 70% of kidney transplant recipients within the first month. Preoperative UTI history and ureteral catheter use increase risk, while donor antibiotic treatment may reduce it.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Context:
- Kidney transplantation is a life-saving procedure but carries risks of post-operative complications.
- Urinary tract infections (UTIs) are common in the early post-transplant period, potentially impacting graft survival.
- Understanding UTI incidence and risk factors is crucial for optimizing patient outcomes.
Purpose:
- To determine the incidence and identify predisposing factors for urinary tract infections (UTIs) within the first month after kidney transplantation.
- To analyze the common causative organisms and recurrence rates of post-transplant UTIs.
- To evaluate the association between various clinical factors and UTI occurrence.
Summary:
- This study analyzed 255 kidney transplantations, revealing a 73.7% incidence of UTIs in the first post-transplant month.
- Escherichia coli and Staphylococcus were the most frequent pathogens. Recurrent infections occurred in 39% of cases, with 7% leading to sepsis.
- While many factors were not associated with increased UTI risk, a history of preoperative UTI and ureteral catheter use were significant risk factors. Donor antibiotic treatment before brain death was associated with a reduced UTI incidence.
Impact:
- The findings underscore the importance of vigilant urine culture monitoring in kidney transplant recipients during the initial post-transplant phase.
- Identifying key risk factors like preoperative UTI history can guide targeted preventative strategies.
- This research contributes to reducing the infectious complications and improving the success rates of kidney transplantation.