BackgroundUrinary tract infections (UTI) are the most common of infections after renal transplantation. The consequences of UTIs in this population are serious, with increased morbidity and hospitalisation rates as well as acute allograft dysfunction. UTIs may impair overall graft and patient survival. We aimed to identify the prevalence and risk factors for post-transplant UTIs and assess UTIs’ effect on renal function during a UTI episode and if they result in declining allograft function at 2 years post-transplant. Additionally, the causative organism, the class of antibacterial drug employed for each UTI episode and utilisation rates of trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were also quantified.MethodsThis was a retrospective study of 72 renal transplant patients over a 5-year period who were managed at the Royal Brisbane and Women’s Hospital. Patient charts, pathology records and dispensing histories were reviewed as part of this study and all UTIs from 2 years post transplantation were captured.ResultsOf these patients, 20 (27.8%) had at least one UTI. Older age (p = 0.015), female gender (p < 0.001), hyperglycaemia (p = 0.037) and acute rejection episodes (p = 0.046) were risk factors for developing a UTI on unadjusted analysis. Female gender (OR 4.93) and age (OR 1.03) were statistically significant risk factors for a UTI on adjusted analysis. On average, there was a 14.4% (SEM 5.20) increase in serum creatinine during a UTI episode, which was statistically significant (p = 0.027), and a 9.1% (SEM 6.23) reduction in serum creatinine after the UTI episode trending toward statistical significance.(p = 0.076). Common organisms (Escherichia coli and Klebsiella pneumoniae) accounted for 82% of UTI episodes with 70% of UTI cases requiring only a single course of antibiotic treatment. Furthermore, the antibiotic class used was either a penicillin (49%) or cephalosporin (36%) in the majority of UTIs. The use of TMP/SMX prophylaxis for Pneumocystis carinii pneumonia prophylaxis did not influence the rate of UTI, with > 90% of the cohort using this treatment.ConclusionsThere was no significant change in serum creatinine and estimated glomerular filtrate rate from baseline to 2 years post-transplant between those with and without a UTI.
Successful resolution of iron deficiency anemia in the context of anticoagulation with rivaroxaban was seen when apixaban is used alternatively. Prospective cohort studies utilizing similar or different approaches are required.
BackgroundCandida endocarditis (CE) is a highly fatal manifestation of candidaemia. Currently, screening for CE is not recommended as a routine in patients presented with candidaemia, as CE is considered rare. The objective of this study was to determine the incidence, risk factors and outcome of CE in candidaemia, in order to guide the screening.MethodsRetrospective chart review of patients with candidaemia from a tertiary center in Australia, admitted between January 2005 and December 2015, was conducted. Clinical characteristics and outcomes of patients with CE and without CE were compared, and logistic regression analyses were performed to identify the risk factors associated with CE and mortality.ResultsEighty-six patients with candidaemia were identified with mean ± SD age of 52 ± 22 years, comprising 51% males. Candida albicans was the most common species (41%). Echocardiogram was performed in 88% of cases. Eleven patients (13%) had CE. Most candidaemia cases were hospital-acquired, but patients with CE were more likely to have community-acquired fungaemia (P < 0.001), dissemination to other organs (P < 0.001), and a cardiac prosthesis (P < 0.05). On logistic regression, community-acquired fungaemia (odds ratio OR: 22.3; P < 0.001) and presence of a cardiac prosthesis (odds ratio OR: 4.0; P < 0.05) were predictors of CE. Overall mortality rates for candidaemia were 14% for 30-day and 16% for 90-day. Mortality was much higher in patients with CE (27% for 30-day and 36% for 90-day), and CE was an independent predictor of candidaemia-related mortality (OR: 6.2; P < 0.05 for 30-day, and OR: 8.3; P < 0.05 for 90-day).ConclusionCE is not rare in candidaemia, and is associated with very high mortality. Low index of suspicion for CE and early investigation with echocardiogram are indicated, especially in patients with cardiac prosthesis or community-acquired candidaemia.Disclosures All authors: No reported disclosures.
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