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| Characteristics of urinary tract infection in kidney transplant recipients and non-recipient patients |
| CHEN Siteng, YU Lixin, DENG Wenfeng, MIAO Yun, LIU Rumin, YE Guirong |
| Department of Organ Transplantation, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China |
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Abstract Objective: To compare the characteristics of urinary tract infection (UTI) between kidney transplant recipients and non-recipient patients. Methods: Forty-nine kidney transplant recipients with UTI (69 episodes) and 401 non-recipient patients with UTI (443 episodes) admitted in Nanfang Hospital from January 2003 to August 2014 were enrolled in the study. The characteristics of UTI were compared between two groups. Results: In both groups of UTI, female patients comprised a greater proportion (63.3% and 58.6%) and Escherichia coli was the most common pathogen isolated (37.7% and 34.1%). However, the infection rate of Klebsiella pneumonia in recipients was higher than that in non-recipients (11.6% vs 3.2%, P= 0.001), while the infection rate of Candida albicans was lower (1.5% vs 11.3%, P=0.008) than that in non-recipients.Recipients were likely to develop antibiotic resistance and with a higher recurrence rate than non-recipient patients (38.8% vs 16.7%, P<0.001). Compared to non-recipient UTI patients, the symptoms of urinary irritation in recipient UTI patients were more common. There was higher percentage of neutrophil granulocyte (72.65%±1.90% vs 68.59%±0.73%, P=0.048), lower proportion of lymphocytes (17.73%±1.27% vs 21.28%±0.61%, P=0.037), and less platelets [(187.64±10.84) ×109/L vs (240.76±5.26)×109/L, P<0.01] in recipients than in non-recipient UTI patients. Conclusion: These results indicate that the characteristics of UTI in kidney transplantation recipients and non-recipients patients are different.
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Received: 26 November 2015
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肾移植受者与普通患者泌尿系统感染的比较
目的: 分析肾移植受者与普通患者泌尿系统感染(UTI)的不同,探究肾移植受者UTI的合理诊治方案。方法: 对2003年1月至2014年8月在南方医院确诊UTI的肾移植受者和普通患者进行回顾性分析,比较两组患者UTI特点。结果: 49例肾移植受者共发生69次UTI,401例普通UTI患者共发生443次UTI;肾移植受者和普通UTI患者均以女性居多(63.3%和58.6%),大肠埃希菌感染频率均最高(37.7%和34.1%);两组UTI患者其他病原体易感性不一致:肾移植受者肺炎克雷伯杆菌频率高于普通患者(11.6%与3.2%,P=0.001),而白色念珠菌频率低于普通患者(1.5%与11.3%,P=0.008);肾移植受者尿路刺激征更多见,更易发生抗生素耐药,感染复发率更高(38.8%与16.7%,P<0.001);肾移植受者发生UTI时外周血中性粒细胞百分率高于普通患者[(72.65±1.90)%与(68.59±0.73)%,P=0.048],淋巴细胞百分率[(17.73±1.29)%与(21.28±0.61)%,P=0.037)]和血小板计数[(187.64±10.84)×109/L与(240.76±5.26)×109/L,P<0.01]均低于普通患者。结论: 肾移植受者与普通患者UTI的特点不尽相同,早期行中段尿培养、合理使用抗生素、及时调整免疫抑制剂剂量对于肾移植受者UTI的防治具有重要意义。
关键词：
肾移植,
泌尿道感染/微生物学,
泌尿道感染/预防和控制,
免疫抑制剂投药和剂量,
回顾性研究,
对比研究
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| [1] SCHMALDIENST S, DITTRICH E, HÖRL W H. Urinary tract infections after renal transplantation[J]. Curr Opin Urol, 2002, 12(2):125-130.
[2] RUBIN R H. Infectious disease complications of renal transplantation[J]. Kidney Int, 1993, 44(1):221-236.
[3] KARAKAYALI H, EMIROLU R, ARSLAN G, et al. Major infectious complications after kidney transplantation[J]. Transplant Proc, 2001, 33(1-2):1816-1817.
[4] GIRAL M, PASCUARIELLO G, KARAM G, et al. Acute graft pyelonephritis and long-term kidney allograft outcome[J]. Kidney Int, 2002, 61(5):1880-1886.
[5] PELLÉ G, VIMONT S, LEVY P P, et al. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function[J]. Am J Transplant, 2007, 7(4):899-907.
[6] SORTO R, IRIZAR S S, DELGADILLO G, et al. Risk factors for urinary tract infections during the first year after kidney transplantation[J]. Transplant Proc, 2010, 42(1):280-281.
[7] ESEZOBOR C I, NOURSE P, GAJJAR P. Urinary tract infection following kidney transplantation: frequency, risk factors and graft function[J]. Pediatr Nephrol, 2012, 27(4):651-657.
[8] ALANGADEN G J, THYAGARAJAN R, GRUBER S A, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors[J].Clin Transplant, 2006, 20(4):401-409.
[9] SQALLI T H, LABOUDI A, ARRAYHANI M, et al. Urinary tract infections in renal allograft recipients from living related donors[J]. Saudi J Kidney Dis Transpl, 2008, 19(4):551-553.
[10] SINGH S, MAHMOOD M, TRACY D S. Estimation of mean and variance of stigmatized quantitative variable using distinct units in randomized response sampling.[J].Statistical Papers, 2001, 42(3):403.
[11] HOOTON T M, BRADLEY S F, CARDENAS D D, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America[J]. Clin Infect Dis, 2010, 50(5):625-663.
[12] SILVA C, AFONSO N, MACÁRIO F, et al. Recurrent urinary tract infections in kidney transplant recipients[J]. Transplant Proc, 2013, 45(3):1092-1095.
[13] PATEL J B, COCKERILL Ⅲ F R, ALDER J, et al. M100-S25 Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement[M]. PA: Clinical and Laboratory Standards Institute, 2014: 131-165.
[14] KARUTHU S, BLUMBERG E A. Common infections in kidney transplant recipients[J]. Clin J Am Soc Nephrol, 2012, 7(12):2058-2070.
[15] PAPASOTIRIOU M, SAVVIDAKI E, KALLIAKMANI P, et al. Predisposing factors to the development of urinary tract infections in renal transplant recipients and the impact on the long-term graft function[J]. Ren Fail, 2011, 33(4):405-410.
[16] SENGER S S, ARSLAN H, AZAP O K, et al. Urinary tract infections in renal transplant recipients[J]. Transplant Proc, 2007, 39(4):1016-1017.
[17] KHOSROSHAHI H T, MOGADDAM A N, SHOJA M M. Efficacy of high-dose trimethoprim-sulfamethoxazol prophylaxis on early urinary tract infection after renal transplantation[J]. Transplant Proc, 2006, 38(7):2062-2064.
[18] RIVERA-SANCHEZ R, DELGADO-OCHOA D, FLORES-PAZ R R, et al. Prospective study of urinary tract infection surveillance after kidney transplantation[J]. BMC Infect Dis, 2010, 10: 245.
[19] KAMATH N S, JOHN G T, NEELAKANTAN N, et al. Acute graft pyelonephritis following renal transplantation[J]. Transpl Infect Dis, 2006, 8(3):140-147.
[20] HORIGOME A, HIRANO T, OKA K. Tacrolimus-induced apoptosis and its prevention by interleukins in mitogen-activated human peripheral-blood mononuclear cells[J]. Immunopharmacology, 1998, 39(1):21-30.
[21] SANTIMONE I, DI CASTELNUOVO A, DE CURTIS A, et al. White blood cell count, sex and age are major determinants of heterogeneity of platelet indices in an adult general population: results from the MOLI-SANI project[J]. Haematologica, 2011, 96(8):1180-1188.
[22] HERZOG B H, FU J, WILSON S J, et al. Podoplanin maintains high endothelial venule integrity by interacting with platelet CLEC-2[J]. Nature, 2013, 502(7469):105-109.
[23] ARIZA-HEREDIA E J, BEAM E N, LESNICK T G, et al. Impact of urinary tract infection on allograft function after kidney transplantation[J]. Clin Transplant, 2014, 28(6):683-690.
[24] BARBOUCH S, CHERIF M, OUNISSI M, et al. Urinary tract infections following renal transplantation: a single-center experience[J]. Saudi J Kidney Dis Transpl, 2012, 23(6):1311-1314.
[25] LINHARES I, RAPOSO T, RODRIGUES A, et al. Frequency and antimicrobial resistance patterns of bacteria implicated in community urinary tract infections: a ten-year surveillance study (2000-2009)[J]. BMC Infect Dis, 2013, 13: 19.
[26] DI COCCO P, ORLANDO G, MAZZOTTA C, et al. Incidence of urinary tract infections caused by germs resistant to antibiotics commonly used after renal transplantation[J]. Transplant Proc, 2008, 40(6):1881-1884.
[27] FIORANTE S, LOPEZ-MEDRANO F, LIZASOAIN M, et al. Systematic screening and treatment of asymptomatic bacteriuria in renal transplant recipients[J]. Kidney Int, 2010, 78(8):774-781.
[28] MORADI M, ABBASI M, MORADI A, et al. Effect of antibiotic therapy on asymptomatic bacteriuria in kidney transplant recipients[J]. Urol J, 2005, 2(1):32-35.
[29] GREEN H, RAHAMIMOV R, GOLDBERG E, et al. Consequences of treated versus untreated asymptomatic bacteriuria in the first year following kidney transplantation: retrospective observational study[J]. Eur J Clin Microbiol Infect Dis, 2013, 32(1):127-131.
[30] PARASURAMAN R, JULIAN K. Urinary tract infections in solid organ transplantation[J]. Am J Transplant, 2013, 13(4):327-336. |
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