[Bacterial and fungal infections in kidney transplant recipients]

Despite advances in the scientific knowledge related to organ transplantation, kidney transplant recipients remain patients who must take immunosuppressive therapy for the rest of their lives to prevent graft rejection. This situation, coupled with the possible need for medical care, whether invasive or noninvasive, and higher hospitalization rates than in the general population, puts the patient with a transplanted kidney at risk of developing infectious diseases. An important threat are bacterial infections of the urinary tract at different levels of severity (from asymptomatic bacteriuria to urinary septicemia), which in recent years have included infections by multidrug-resistant bacteria. Careful attention must be paid therefore to the overall management of kidney transplant recipients with infections and to the "ecological" use of antibiotic therapy, which aims at preventing antibiotic resistance according to the recent concept of antibiotic stewardship. Among the fungal infections candida infections require special consideration. As with bacterial infections, there may be different degrees of severity ranging from candiduria (where some see no indication for treatment) to pyelonephritis and candidemia, conditions that may lead to vascular complications and the possible rupture of blood vessels. The key to success in the fight against infections after kidney transplant lies in the multidisciplinary approach to their management, with the involvement of the nephrologist, transplant surgeon, infectiologist, clinical microbiologist and clinical pharmacologist.