Open Journal Systems

Urinary tract infections due to multiresistant microorganisms in hospitalized renal transplant recipients

Rubén Schiavelli, Martín Ajzenszlos, Daniel Di Tullio, Nelson Rojas Campoverde, Elena Maiolo, Fernando Margulis, Nora Gómez, Roberto Sabbatiello, Mauricio Pattin, Miguel Raño

Article ID: 2031
Vol 2, Issue 1, 2021

DOI: https://doi.org/10.54517/urr.v2i1.2031
VIEWS - 43 (Abstract)

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

renal transplantation; urinary tract infections; multidrug-resistant germs; morbidity and mortality; renal function.

Full Text:

PDF

References

1. Suthanthiran M1, Strom TB. Renal transplantation. N Engl J Med. 1994;331(6):365-76.

2. Port FK, Wolfe RA, Mauger EA, Berling DP, Jiang K. Comparison of survival probabilities for dialysis patients vs cadaveric renal transplant recipients. JAMA. 1993;270(11)：1339-43.

3. Schnuelle P, Lorenz D, Trede M, Van Der Woude FJ. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol. 1998;9(11):2135-41.

4. Wu MJ, Yu TM, Lin CL, Kao CH. Propensity Score- Matched Analysis of the Survival Benefit from Kidney Transplantation in Patients with End-Stage Renal Disease. J Clin Med. 2018;7(11):E388.

5. Parasuraman R, Julian K; AST Infectious Diseases Community of Practice. Urinary tract infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):327-36.

6. Wu X, Dong Y, Liu Y, Li Y, Li Y, Sun Y, Wang J, et al. The prevalence and predictive factors of urinary tract infec¬tion in patients undergoing renal transplantation: A meta-analysis. Am J Infect Control. 2016;44(11):1261-68.

7. Chacón-Mora N, Pachón Díaz J, Cordero Matía E. Urinary tract infection in kidney transplant recipients. Enferm Infecc Microbiol Clin. 2017;35(4):255-9.

8. Schmaldienst S, Dittrich E, Horl WH. Urinary tract infections after renal transplantation. Curr Opin Urol. 2002;12(2):125-30.

9. Fishman JA. Infection in solid-organ transplant recipients. N Engl J Med. 2007;357(25):2601-14.

10. Veroux M, Giuffrida G, Corona D, Gagliano M, ScriffignanoV,VizcarraD,etal. Infectivecomplications in renal allograft recipients: epidemiology and outcome. Transplant Proc. 2008;40(6):1873-6.

11. Hollyer I, Ison MG. The challenge of urinary tract infections in renal transplant recipients. Transpl Infect Dis. 2018;20(2):e12828.

12. Shohab D, Khawaja A, Atif E, Jamil I, Ali I, Akhter S. Frequency of occurrence of urinary tract infection in double j stented versus non-stented renal transplant recipients. Saudi J Kidney Dis Transpl. 2015;26(3):443-6.

13. Galindo Sacristán P, Pérez Marfil A, Osorio Moratalla JM, de Gracia Guindo C, Ruiz Fuentes C, Castilla Barbosa YA, et al. Predictive factors of infection in the first year after kidney transplantation. Transplant Proc. 2013;45(10):3620-3.

14. Aguado JM, Silva JT, Fernández-Ruiz M, Cordero E, Fortún J, Gudiol C, et al. Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/ REIPI recommendations. Transplant Rev (Orlando). 2018;32(1):36-57.

15. van Duin D, van Delden C; AST Infectious Diseases Community of Practice. Multidrug-resistant gram-negative bacteria infections in solid organ transplantation. Am J Transplant. 2013;13(Suppl 4):31-41.

16. Bodro M, Sanclemente G, Lipperheide I, Allali M, Marco F, Bosch J, et al. Impact of antibiotic resistance on the development of recurrent and relapsing symptomatic urinary tract infection in kidney recipients. Am J Transplant. 2015;15(4):1021-7.

17. Antimicrobial Service, Bacteriology Department, National Institute of Infectious Diseases (INEI) - ANLIS Dr. Carlos G. Malbrán. Red WHONET Argentina working protocol [Internet]. Buenos Aires, 2017. 48 p. Available from: http://antimicrobia- nos.com.ar/ATB/wp-content/uploads/2014/10/Proto- colo-WHONET-consensuado-2017-final.pdf (cited: 18/02/2019).

18. Trzeciak S, Sharer R, Piper D, Chan T, Kessler C, Dellinger RP, et al. Infections and severe sepsis in solid¬organ transplant patients admitted from a university¬based ED. Am J Emerg Med. 2004;22(7):530-3.

19. Karakayali H, Emiroglu R, Arslan G, Bilgin N, Haber- al M. Major infectious complications after kidney trans¬plantation. Transplant Proc. 2001;33(1-2):1816-7.

20. Müller V, Becker G, Delfs M, Albrecht KH, Philipp T, Heemann U. Do urinary tract infections trigger chronic kidney transplant rejection in man? J Urol. 1998;159(6):1826-9.

21. Fiorentino M, Pesce F, Schena A, Simone S, Castellano G, Gesualdo L. Updates on urinary tract infections in kidney transplantation. J Nephrol. 2019 Jan.

22. Gozdowska J, Czerwinska M, Chabros 匕，Mlynarczyk G, Kwiatkowski A, Chmura A, et al. Urinary Tract Infections in Kidney Transplant Recipients Hospitalized at a Transplantation and Nephrology Ward: 1-Year Follow-up. Transplant Proc. 2016;48(5):1580-9.

23. Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, et al. Infectious compli¬cations after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006;20(4):401-9.

24. Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant. 2005;19(2):230-5.

25. Jung GO, Chun JM, Park JB, Choi GS, Kwon CH, Joh JW, et al. Clinical significance of posttransplantation vesicoureteral reflux during short¬term period after kidney transplantation. Transplant Proc. 2008;40(7):2339-41.

26. Wu SW, Liu KS, Lin CK, Hung TW, Tsai HC, Chang HR, et al. Community-acquired urinary tract infection in kidney transplantation: risk factors for bacteremia and recurrent infection. J Formos Med Assoc. 2013;112(3):138-43.

27. Siskind E, Sameyah E, Goncharuk E, Olsen EM, Feldman J, Giovinazzo K, et al. Removal of foley catheters in live donor kidney transplant recipients on postoperative day 1 does not increase the incidence of urine leaks. Int JAngiol. 2013;22(1):45-8.

28. Dantas SR, Kuboyama RH, Mazzali M, Moretti ML. Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect. 2006;63 (2) :117-23.

29. Guler S, Cimen S, Hurton S, Molinari M. Risks and Benefits of Early Catheter Removal After Renal Transplantation. Transplant Proc. 2015;47(10):2855-9.

30. Sagalowsky AI, Ransler CW, Peters PC, Dickerman RM, Gailiunas P, Helderman, et al. Urologic complications in 505 renal transplants with early catheter removal. J Urol. 1983;129(5):929-32.

31. Rabkin DG, Stifelman MD, Birkhoff J, Richardson KA, Cohen D, Nowygrod R, et al. Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplant Proc. 1998;30(8):4314-6.

32. Glazer ES, Akhavanheidari M, Benedict K, James S, Molmenti E. Cadaveric renal transplant recipients can safely tolerate removal of bladder catheters within 48 h of transplantation. Int JAngiol. 2009;18(2):69-70.

33. Cai JF, Wang W, Hao W, Sun ZJ, Su LL, Li X, et al. Meta-analysis of Early Versus Late Ureteric Stent Removal After Kidney Transplantation. Transplant Proc. 2018;50(10):3411-5.

34. Osthoff M, McGuinness SL, Wagen AZ, Eisen DP. Urinary tract infections due to extended-spectrum beta-lactamase-producing Gram-negative bacteria: identification of risk factors and outcome predictors in an Australian tertiary referral hospital. Int J Infect Dis. 2015;34:79-83.

35. Del Rosario-Quintana C, Tosco-Núñez T, Lorenzo L, Martín-Sánchez AM, Molina-Cabrillana J. [Prevalence and risk factors of multi-drug resistant organism colonization among long-term care facilities in Gran Canaria (Spain)]. Rev Esp Geriatr Gerontol. 2015;50(5):232-6.

36. Ooms L, IJzermans J, Voor In 't Holt A, Betjes M, Vos M, Terkivatan T. Urinary Tract Infections After Kidney Transplantation: A Risk Factor Analysis of 417 Patients. Ann Transplant. 2017;22:402-8.

37. Tawab KA, Gheith O, Al Otaibi T, Nampoory N, Mansour H, Halim MA, et al. Recurrent Urinary Tract Infection Among Renal Transplant Recipients: Risk Factors and Long-Term Outcome. Exp Clin Transplant. 2017;15(2):157-63.

38. Cárdenas-Perea ME, Cruz y López OR, Gándara- Ramírez JL, Pérez-Hernández MA. Bacterial virulence factors: the "intelligence" of bacteria. Elements. 2014;21(94):35-43.

39. Sahly H, Keisari Y, Ofek I. Manno(rhamno)biose-containing capsular polysaccharides of Klebsiella pneumoniae enhance opsono-stimulation of human polymorphonuclear leukocytes. J Innate Immun. 2009;1(2):136-44.

40. Hollyer I, Ison MG. The challenge of urinary tract infections in renal transplant recipients. Transpl Infect Dis. 2018;20(2):e12828.

41. Song JC, Hwang HS, Yoon HE, Kim JC, Choi BS, Kim YS, et al. Endoscopic subureteral polydimethylsiloxane injection and prevention of recurrent acute graft pyelonephritis. Nephron Clin Pract. 2011;117(4):c385-9.

42. Dupont PJ, Psimenou E, Lord R, Buscombe JR, Hilson AJ, Sweny P. Late recurrent urinary tract infections may produce renal allograft scarring even in the absence of symptoms or vesicoureteric reflux. Transplantation. 2007;84(3):351-5.

43. Brizendine KD, Richter SS, Cober ED, van Duin D. Carbapenem-resistant Klebsiella pneumoniae urinary tract infection following solid organ transplantation. Antimicrob Agents Chemother. 2015;59(1):553-7.

44. Reddy P, Zembower TR, Ison MG, Baker TA, Stosor V. Carbapenem-resistant Acinetobacter baumannii infections after organ transplantation. Transpl Infect Dis. 2010;12(1):87-93.

45. Kawecki D, Kwiatkowski A, Sawicka-Grzelak A, Durlik M, Paczek L, Chmura A, et al. Urinary tract infections in the early posttransplant period after kidney transplantation: etiologic agents and their susceptibility. Transplant Proc. 2011;43(8):2991-3.

46. Pellé G, Vimont S, Levy PP, Hertig A, Ouali N, Chassin C, et al. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant. 2007;7(4):899-907.

47. Naik AS, Dharnidharka VR, Schnitzler MA, Brennan DC, Segev DL, Axelrod D, et al. Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice. Transpl Int. 2016;29(2):241-52.

48. Abbott KC, Swanson SJ, Richter ER, Bohen EM, Agodoa LY, Peters TG, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis. 2004;44 (2):353-62.