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Wang Peiyu, Ding Handong, Zhong Jinbiao, et al. Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024095
Citation: Wang Peiyu, Ding Handong, Zhong Jinbiao, et al. Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2024095
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Clinical characteristics and risk factors of 209 cases of urinary tract infection after kidney transplantation

doi: 10.3969/j.issn.1674-7445.2024095

  • Department of Urology, the First Affiliated Hospital of Anhui Medical University, Institute of Urology, Anhui Medical University, Anhui Province Key Laboratory of Urological and Andrological Diseases Research and Medical Transformation, Hefei 230022, China

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  • Corresponding author: Liang Chaozhao, Email: liang_chaozhao@163.com
  • Received Date: 2024-03-15
    Available Online: 2024-04-28
    Abstract
  •   Objective  To investigate clinical characteristics and risk factors of different stages of urinary tract infection after kidney transplantation.   Methods  Clinical data of 209 kidney transplant recipients were retrospectively analyzed. According to time points of postoperative follow-up, all recipients were divided into 3 stages: within 1 month post-kidney transplantation, 1-6 months post-kidney transplantation, and 7-12 months post-kidney transplantation. The incidence of urinary tract infection, urine culture results of recipients with urinary tract infection and drug resistance characteristics of common pathogens during different stages after kidney transplantation were analyzed. The strains of patients with recurrent urinary tract infection were identified. The risk factors of urinary tract infection and the effect of urinary tract infection on renal allograft function were analyzed.   Results  The urinary tract infection rate was 90.0% in the first stage, 49.3% in the second stage and 22.5% in the third stage. The urinary tract infection rates of male recipients undergoing living-related organ donation in the second and third stages were lower than those of female recipients (both P＜0.05). Urine culture test yielded positive results in 60 cases, and 84 strains of pathogenic bacteria were detected, mainly Gram-negative bacteria, among which Klebsiella pneumoniae accounted for the highest proportion. Sixty-six recipients had recurrent urinary tract infection, and the detected pathogens included Klebsiella pneumoniae, Escherichia coli and Candida glabrata, etc. Univariate analysis showed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage. Preoperative urinary tract infection and donor type were the risk factors for urinary tract infection in the second stage. Gender and age of the recipients were the risk factors for urinary tract infection in the third stage. Multivariate analysis revealed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage. Gender and age of the recipients were the risk factors for urinary tract infection in the third stage (all P＜0.05). In the third stage, 65 cases were cured and 38 cases were not cured. There were no significant differences in serum creatinine level and white blood cell count in the untreated recipients before and after corresponding treatment (both P＜0.05).   Conclusions  Gram-negative bacteria are the main pathogens of urinary tract infection in kidney transplant recipients, and drug resistance is relatively high. Postoperative use of antithymocyte globulin, female and old age are the risk factors for urinary tract infection in kidney transplant recipients.

     

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    • References(38)
  • [1]
    BRUNE JE, DICKENMANN M, WEHMEIER C, et al. Impact of different urinary tract infection phenotypes within the first year post-transplant on renal allograft outcomes[J]. Am J Transplant, 2022, 22(7): 1823-1833. DOI: 10.1111/ajt.17026.
    [2]
    龚丽英, 张鲁伟, 刘晓立, 等. 肾移植术后泌尿系感染的研究进展[J/CD]. 实用器官移植电子杂志, 2021, 9(4): 327-332. DOI: 10.3969/j.issn.2095-5332.2021.04.016.

    GONG LY, ZHANG LW, LIU XL, et al. Research progress on urinary tract infections after kidney transplantation[J]. Pract J Organ Transplant (Electr Vers), 2021, 9(4): 327-332. DOI: 10.3969/j.issn.2095-5332.2021.04.016.
    [3]
    AGRAWAL A, ISON MG, DANZIGER-ISAKOV L. Long-term infectious complications of kidney transplantation[J]. Clin J Am Soc Nephrol, 2022, 17(2): 286-295. DOI: 10.2215/CJN.15971020.
    [4]
    HOSSEINPOUR M, PEZESHGI A, MAHDIABADI MZ, et al. Prevalence and risk factors of urinary tract infection in kidney recipients: a meta-analysis study[J]. BMC Nephrol, 2023, 24(1): 284. DOI: 10.1186/s12882-023-03338-4.
    [5]
    NASCIMENTO EHG, NASCIMENTO E, LASMAR MF, et al. Effects of bacterial urinary tract infection on clinical outcome and survival of kidney transplant patients[J]. Transplant Proc, 2022, 54(5): 1262-1269. DOI: 10.1016/j.transproceed.2022.03.031.
    [6]
    MOEIN M, GARN RM, SETTINERI J, et al. Urinary tract infection 1 year after kidney transplant: effect on kidney transplant outcomes[J]. Exp Clin Transplant, 2023, 21(7): 556-561. DOI: 10.6002/ect.2023.0057.
    [7]
    DUPONT PJ, PSIMENOU E, LORD R, et al. Late recurrent urinary tract infections may produce renal allograft scarring even in the absence of symptoms or vesicoureteric reflux[J]. Transplantation, 2007, 84(3): 351-355. DOI: 10.1097/01.tp.0000275377.09660.fa.
    [8]
    COUSSEMENT J, ARGUDÍN MA, HEINRICHS A, et al. Host and microbial factors in kidney transplant recipients with Escherichia coli acute pyelonephritis or asymptomatic bacteriuria: a prospective study using whole-genome sequencing[J]. Nephrol Dial Transplant, 2019, 34(5): 878-885. DOI: 10.1093/ndt/gfy292.
    [9]
    KRÓLICKI T, BARDOWSKA K, KUDLA T, et al. Acute kidney injury secondary to urinary tract infection in kidney transplant recipients[J]. Sci Rep, 2022, 12(1): 10858. DOI: 10.1038/s41598-022-15035-7.
    [10]
    JAMIL S, ZAFAR MN, SIDDIQUI S, et al. Recurrent urinary tract infections in renal transplant recipients: risk factors and outcomes in low-resource settings[J]. Saudi J Kidney Dis Transpl, 2022, 33(6): 761-773. DOI: 10.4103/1319-2442.390256.
    [11]
    ZGOURA P, WALDECKER C, BAUER F, et al. Vaccination against urinary tract infection after renal transplantation[J]. Transplant Proc, 2020, 52(10): 3192-3196. DOI: 10.1016/j.transproceed.2020.06.018.
    [12]
    SAAD EJ, FERNÁNDEZ P, CARDOZO AZUA AE, et al. Infections in the first year after renal transplant[J]. Medicina (B Aires), 2020, 80(6): 611-621.
    [13]
    张艺舰, 何龙, 杨宏伟, 等. 脑死亡后器官捐献肾移植术后泌尿系感染危险因素的单中心临床研究[J]. 现代泌尿外科杂志, 2023, 28(2): 141-144. DOI: 10.3969/j.issn.1009-8291.2023.02.013.

    ZHANG YJ, HE L, YANG HW, et al. Risk factors of urinary tract infection after renal transplantation[J]. J Mod Urol, 2023, 28(2): 141-144. DOI: 10.3969/j.issn.1009-8291.2023.02.013.
    [14]
    GAD MM, RASMUSSEN MK, LADEFOGED HB, et al. The phenomenon of urinary tract infection experienced by women with a kidney transplant[J]. J Ren Care, 2023,DOI: 10.1111/jorc.12467[Epub ahead of print].
    [15]
    EVANS S, SILSKI L. The evaluation of technical urinary tract complications in kidney transplantation recipients with a prolonged dialysis history[J]. Surgery, 2023, 174(2): 142-143. DOI: 10.1016/j.surg.2023.03.015.
    [16]
    MARTIN SP, LUM C, KUSHWAHA K, et al. Evaluation of technical urinary tract complications in kidney transplantation recipients with a prolonged dialysis history[J]. Surgery, 2023, 174(2): 136-141. DOI: 10.1016/j.surg.2023.02.013.
    [17]
    KLEINOVA P, BELIANCINOVA M, VNUCAK M, et al. Urinary tract infection in the context of mini-invasive procedures after kidney transplantation[J]. Bratisl Lek Listy, 2023, 124(10): 727-732. DOI: 10.4149/BLL_ 2023_110.
    [18]
    SHARMA S, SHARMA N. Urinary tract infection in renal transplant recipients: incidence, microbiological profile and predisposing factors in India[J]. Transplant Proc, 2023, 55(5): 1310-1311. DOI: 10.1016/j.transproceed.2023.04.025.
    [19]
    HALSKOV ACL, DAGNÆS-HANSEN J, STROOMBERG HV, et al. Incidence of and risk factors for recurrent urinary tract infections in renal transplant recipients[J]. Eur Urol Open Sci, 2023, 52: 115-122. DOI: 10.1016/j.euros.2023.04.001.
    [20]
    李明霞, 彭贵主, 曾宪鹏, 等. 肾移植后尿路感染危险因素荟萃分析[J]. 中华器官移植杂志, 2016, 37(3): 159-164. DOI: 10.3760/cma.j.issn.0254-1785.2016.03.007.

    LI MX, PENG GZ, ZENG XP, et al. Meta-analysis of the risk factors of urinary tract infection after renal transplantation[J]. Chin J Organ Transplant, 2016, 37(3): 159-164. DOI: 10.3760/cma.j.issn.0254-1785.2016.03.007.
    [21]
    EL HENNAWY HM, SAFAR O, AL FAIFI AS, et al. Recurrent urinary tract infection in living donor renal transplant recipients and the role of behavioral education program in management: a single-center experience[J]. Transplant Proc, 2023, 55(1): 103-108. DOI: 10.1016/j.transproceed.2022.09.032.
    [22]
    FIORENTINO M, PESCE F, SCHENA A, et al. Updates on urinary tract infections in kidney transplantation[J]. J Nephrol, 2019, 32(5): 751-761. DOI: 10.1007/s40620-019-00585-3.
    [23]
    WANG Q, ZHAO K, GUO C, et al. Antibiotic resistance and virulence genes of escherichia coli isolated from patients with urinary tract infections after kidney transplantation from deceased donors[J]. Infect Drug Resist, 2021, 14: 4039-4046. DOI: 10.2147/IDR.S332897.
    [24]
    ALGHORAIBI H, ASIDAN A, ALJAWAIED R, et al. Recurrent urinary tract infection in adult patients, risk factors, and efficacy of low dose prophylactic antibiotics therapy[J]. J Epidemiol Glob Health, 2023, 13(2): 200-211. DOI: 10.1007/s44197-023-00105-4.
    [25]
    NEJAD MK, HASANI A, SOOFIYANI SR, et al. Aptitude of uropathogenic Escherichia coli in renal transplant recipients: a comprehensive review on characteristic features, and production of extended spectrum β-lactamase[J]. Curr Microbiol, 2023, 80(12): 382. DOI: 10.1007/s00284-023-03476-w.
    [26]
    JAWORSKA MM, PECYNA P, JASKIEWICZ K, et al. Differences in the composition of the bacterial element of the urinary tract microbiome in patients undergoing dialysis and patients after kidney transplantation[J]. Front Microbiol, 2023, 14: 1187625. DOI: 10.3389/fmicb.2023.1187625.
    [27]
    ARIZA-HEREDIA EJ, BEAM EN, LESNICK TG, et al. Impact of urinary tract infection on allograft function after kidney transplantation[J]. Clin Transplant, 2014, 28(6): 683-690. DOI: 10.1111/ctr.12366.
    [28]
    KHATRI B, MAHARJAN S, LAMSAL J, et al. Urinary tract infection among post-renal transplant patients in the department of nephrology of a tertiary care centre: a descriptive cross-sectional study[J]. JNMA J Nepal Med Assoc, 2022, 60(250): 507-510. DOI: 10.31729/jnma.7496.
    [29]
    SILIANO PR, ROCHA LA, MEDINA-PESTANA JO, et al. The role of host factors and bacterial virulence genes in the development of pyelonephritis caused by Escherichia coli in renal transplant recipients[J]. Clin J Am Soc Nephrol, 2010, 5(7): 1290-1297. DOI: 10.2215/CJN.06740909.
    [30]
    RICE JC, PENG T, KUO YF, et al. Renal allograft injury is associated with urinary tract infection caused by Escherichia coli bearing adherence factors[J]. Am J Transplant, 2006, 6(10): 2375-2383. DOI: 10.1111/j.1600-6143.2006.01471.x.
    [31]
    王晓丹, 王媛, 崔向宇, 等. 上尿路结石内镜手术后尿源性脓毒血症病原菌耐药及死亡高危因素分析[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(6): 611-615. DOI: 10.3877/cma.j.issn.1674-3253.2023.06.013.

    WANG XD, WANG Y, CUI XY, et al. Analysis of pathogenic bacteria resistance of drug and high risk factors of death in urogenic sepsis after endoscopic surgery for upper urinary tract stones[J/CD]. Chin J Endourol (Electr Edit), 2023, 17(6): 611-615. DOI: 10.3877/cma.j.issn.1674-3253.2023.06.013.
    [32]
    LEE JR, SATLIN MJ. Case commentary: unlocking the potential of bacteriophage to prevent recurrent urinary tract infections after kidney transplantation[J]. Antimicrob Agents Chemother, 2023, 67(6): e0044923. DOI: 10.1128/aac.00449-23.
    [33]
    胡亚会, 周鹏飞, 杨国强, 等. 肾脏移植术后感染患者病原菌分布及耐药性分析[J]. 中国抗生素杂志, 2021, 46(1): 81-86. DOI: 10.3969/j.issn.1001-8689.2021.01.013.

    HU YH, ZHOU PF, YANG GQ, et al. Analysis of pathogen distribution and drug resistance in patients infected after renal transplantation[J]. Chin J Antibiotics, 2021, 46(1): 81-86. DOI: 10.3969/j.issn.1001-8689.2021.01.013.
    [34]
    WANG Y, LEI H, ZHANG Y, et al. Epidemiology of carbapenem-resistant Klebsiella pneumonia bloodstream infections after renal transplantation from donation after cardiac death in a Chinese hospital: a case series analysis[J]. Antimicrob Resist Infect Control, 2018, 7: 66. DOI: 10.1186/s13756-018-0355-8.
    [35]
    PERDIGÃO NETO LV, MACHADO AS, DA SILVA RG, et al. Case report: successful treatment of recurrent urinary tract infection due to extensively drug-resistant klebsiella pneumoniae in a kidney transplant recipient using chloramphenicol[J]. Transplant Proc, 2023, 55(3): 654-659. DOI: 10.1016/j.transproceed.2023.02.019.
    [36]
    朱兰, 王志强, 马科, 等. 肾移植术后供肾来源CRKP感染13例成功防治的临床经验[J]. 中华器官移植杂志, 2019, 40(6): 328-333. DOI: 10.3760/cma.j.issn.0254-1785.2019.06.003.

    ZHU L, WANG ZQ, MA K, et al. Prevention and treatment of graft-carried carbapenem-resistant Klebsiella pneumoniae infection after kidney transplantation: a report of 13 cases[J]. Chin J Organ Transplant, 2019, 40(6): 328-333. DOI: 10.3760/cma.j.issn.0254-1785.2019.06.003.
    [37]
    吴佳晋, 李大伟, 张明, 等. 肾移植术后供肾来源耐碳青霉烯类肺炎克雷伯菌感染九例诊疗经验[J]. 中华器官移植杂志, 2019, 40(6): 334-338. DOI: 10.3760/cma.j.issn.0254-1785.2019.06.004.

    WU JJ, LI DW, ZHANG M, et al. Diagnosis and treatment in 9 cases of donor-derivedcarbapenem-resistant Klebsiella pneumoniae infection after kidney transplantation[J]. Chin J Organ Transplant, 2019, 40(6): 334-338. DOI: 10.3760/cma.j.issn.0254-1785.2019.06.004.
    [38]
    WANG Q, LIAO G, XIA Q, et al. Safety and effectiveness of tigecycline combination therapy in renal transplant patients with infection due to carbapenem-resistant gram-negative bacteria[J]. Front Cell Infect Microbiol, 2023, 13: 1215288. DOI: 10.3389/fcimb.2023.1215288.
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