Renal transplant sonrası iki yıllık izlemde gelişen üriner sistem enfeksiyonlarının değerlendirilmesi: Tek merkez deneyimi

Tuğba Sari, Belda Dursun, Mevlüt Çeri, H. Turgut, Murat Özban
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Abstract

Introduction:After renal transplantation, urinary tract infection (UTI) is observed in 23-75% of cases. In this study, we aimed to investigate the incidence of UTIs after renal transplantation, the causative pathogens and the predisposing factors that increase the risk. Methodology: Patients who underwent renal transplantation in our hospital between 2016-2017 were included in the study. Results: Twenty-five patients who underwent kidney transplantation were included in the study. UTI was detected in 12 patients (48%). One patient had neurogenic bladder, three had nephrolithiasis and one had vesicoureteral reflux. 8 of the patients had at least two UTI attacks. In total 38 UTI attacks; There were 7 (18.4%) nitrite positivity. UTI was detected in 15 (39.5%) patients during the first 3 months after transplantation. While 7 (18.4%) of the urine cultures were gram positive and 27 (71.1%) were gram negative bacteria, 4 (10.5%) were found as contamination. Escherichia coli (34.2%) was the most common causative agent, followed by Klebsiella pneumoniae (21.1%), Enterococcus faecium (18.4%), Pseudomonas aeruginosa (5.3%) and other gram negative (%). 10.5) uropathogens were found to be followed. When compared with basal and UTI GFR (glomerular filtration rate) levels, the GFR values detected during UTI were decreased significantly (p = 0.00). The most frequently preferred antibiotics in UTI treatment were ertapenem 42.1%, levofloxacin 10.5%, seftriaxon 10.5% and fosfomycin 10.5%. Discussion: Improperly treated UTI negatively affects the outcome of transplantation and increases mortality. Therefore, risk factors, antibiotic resistance and empirical treatments should be reviewed and treatment success should be increased.
肾移植术后23-75%的患者出现尿路感染(UTI)。本研究旨在探讨肾移植术后尿路感染的发生率、致病病原体及增加风险的易感因素。方法:选取2016-2017年在我院行肾移植手术的患者为研究对象。结果:25例接受肾移植的患者被纳入研究。12例(48%)患者检出尿路感染。1例有神经性膀胱,3例有肾结石,1例有膀胱输尿管反流。8例患者至少有2次尿路感染发作。总共38次UTI攻击;亚硝酸盐阳性7例(18.4%)。15例(39.5%)患者在移植后3个月内检出尿路感染。其中革兰氏阳性7例(18.4%),革兰氏阴性27例(71.1%),污染4例(10.5%)。病原菌以大肠杆菌(34.2%)最多,其次为肺炎克雷伯菌(21.1%)、屎肠球菌(18.4%)、铜绿假单胞菌(5.3%)和其他革兰氏阴性菌(%)。10.5)尿路病原菌随访。与基础和UTI GFR(肾小球滤过率)水平相比,UTI期间检测到的GFR值显著降低(p = 0.00)。在UTI治疗中,最常用的抗生素是厄他培南(42.1%)、左氧氟沙星(10.5%)、塞曲松(10.5%)和磷霉素(10.5%)。讨论:处理不当的尿路感染会对移植结果产生负面影响,并增加死亡率。因此,应审查危险因素、抗生素耐药性和经验性治疗,提高治疗成功率。
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