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Urinary tract infections due to multiresistant microorganisms in hospitalized renal transplant recipients
Vol 2, Issue 1, 2021
VIEWS - 772 (Abstract)
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Abstract
Introduction: There is currently an increase in urinary tract infections in kidney transplant recipients due to multidrug-resistant organisms (MRO), which have become a medical challenge.
Objective: To describe the prevalence of urinary tract infection (UTI) due to RMO in hospitalized renal transplant patients (PTxR), their risk factors, treatment and evolution at 1 year.
Material and methods: medical records and cultures of hospitalized PTxR infectious with OMR in the period between 1/1/2016 and 31/12/2017 were reviewed. Risk factors such as: gender, advanced age, prolonged presence of double J catheter, surgical complications and prolonged hospitalization and renal function at hospitalization, at discharge and at one year and the occurrence of rejections at one year were evaluated. Results: The presence of multidrug-resistant germs was found in 58 PTxR (31.18%) who presented 105 episodes of UTI, 36 had a single infection and 22 P had more than one. 55.17% (32) were male and the mean age was 50.52 ±14.24 years. Of the total number of patients, 43 (74.15%) had risk factors such as: late removal of the double J catheter in 8 (13.8%), surgical complications in 11 (18.9%), prolonged inter- nation in 12 (20.7%) and 18 (31.03%) were older than 60 years. Nine patients required dialysis, 4 of whom recovered renal function. Creatinine at hospitalization in patients who did not require dialysis was 1.8 (1.39 - 3.01) mg/dl; at discharge 1.5 (1.1 - 2.1) mg/dl (p=0.025) and at one year it was 1.5 (1.18 - 2.1) mg/dl with no significant difference with respect to that at discharge (p=0.089). In the annual follow-up 5 patients died and 5 lost the graft. The incidence of rejection was 15.51%. The germs rescued were 13 A. baumanii cpx. (ABA) (11.92%), E. coli (ECO) 24 (22.01%), Enterobacter spp. 4 (3.66%), Enterococ- cus spp. 3 (2.75%), Klebsiella spp. 58 (53.21%), Serratia spp. 5 (4.58%), Proteus spp. 1 (0.91%) and Pseudomonas aeruginosa (PAE)1 (0.91). Of the 105 episodes of UTI, 79 were treated with monotherapy: 57 with carbapenem (54.28%), 10 with Colistin (9.51%), 4 with Linezolid (3.8%), 4 with Piperacillin+Tazobactam (3.8%), 3 with Ciprofloxacin (2.85%) and 1 with Nitrofurantoin (0.95%). In 26 episodes combined therapies of Carbapenem were used in 21 cases, colis- tin in 14, amikacin in 13, fosfomycin in 2 and tigecycline in 1 and ciprofloxacin in another. Conclusion: ORM UTIs were frequent and similar to those described in other series. No differences were found in the evolution of renal function, in rejections, in mortality in ORM UTIs with or without associated risk factors, nor was there any influence of recurrent or recurrent UTIs. Further studies with a larger number of patients are needed to evaluate the prognosis and evolution of patients with these infections.
Keywords
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Prof. Wei-Yen Hsu
National Chung Cheng University, Taiwan
