Risk factors and etiology of repeat infection in kidney transplant recipients

Abstract

Kidney transplantation (KT) is the best therapy available for patients with end-stage renal disease, but postoperative infections are a significant cause of mortality.In this retrospective study the frequency, risk factors, causative pathogens, and clinical manifestations of infection in KT recipients from Beijing Chao-Yang Hospital, Capital Medical University were investigated. Ninety-seven KT recipients who were hospitalized with infection between January 2010 and December 2016 were included. Clinical characteristics, surgery details, laboratory results, and etiology were compared in patients who developed single infection and patients who developed repeated infection (2 or more) after KT.A total of 161 infections were adequately documented in a total of 97 patients, of which 57 patients (58.8%) had 1 infection, 24 (24.7%) had 2, 11 (11.3%) had 3; 3 (3.1%) had 4, and 2 (2.1%) had 5 or more. The most common infection site was the urinary tract (90 infections; 56%), both overall and in the repeated infection group. The most frequently isolated pathogen was Pseudomonas aeruginosa. In the repeated infection patients, in most cases of P. aeruginosa infection (54%) it was cultured from urine. For first infections, a time between KT and infection of ≤ 21 days (area under receiver operating characteristic curve [AUC] 0.636) and a tacrolimus level ≥ 8 ng/mL (AUC 0.663) independently predicted repeat infection. The combination of these two predictive factors yielded an AUC of 0.716, which did not differ statistically significantly from either predictor alone.With regard to first infections after KT, a time between KT and infection of ≤ 21 days, and a tacrolimus level ≥ 8 ng/mL each independently predicted repeated infection in KT recipients.

Analysis of risk factors for early urinary tract infection after kidney transplantation

“…The reason for the high early UTI incidence may be that the medical staff still need to improve in the early prevention and treatment of UTIs after kidney transplantation, such as in their theoretical knowledge, patient monitoring, and patient education. Our study showed that the median time of early-stage UTI was 5 [4,10] days after surgery. This finding indicates that 4-10 days after kidney transplantation is a critical period for preventing UTI.…”

“…The recipient and graft survival rates are higher than 90% at 1 year after kidney transplantation (10). However, the survival of both recipient and graft still face many risks, among which UTI is the most common postoperative infectious complication (11).…”

“…All recipients were transplanted for the first time, and the source of the kidney was Donation Among the 129 recipients, 62 patients had UTI within one month after kidney transplantation (48.1%), of whom 25 were male (40.3%) and 37 were female (59.7%). The median time of UTI occurrence was 5[4][5][6][7][8][9][10] days after operation, the shortest being 1 day and the longest being 22 days. Among the 2,915 urine culture samples, 243 specimens had pathogens, and 186 specimens were contaminated.…”

Microbial Predominance and Antimicrobial Resistance in a Tertiary Hospital in Northwest China: A Six-Year Retrospective Study of Outpatients and Patients Visiting the Emergency Department

“…ere is a trend for the Emergency Department to handle more previously inpatient cares. e increased importance of the Kidney Transplantation Department indicates that Kidney Transplantation is becoming a mainstream medical service and repeated infection after kidney transplantation is an urgent medical issue in outpatient clinics [18].…”

How to Treat Asymptomatic and Symptomatic Urinary Tract Infections in the Kidney Transplant Recipients?

“…The mortality rates in kidney transplant recipients (KTR) are approximately 8.6% within the five years of the transplantation. Among them, 53% are secondary to an infection elsewhere in the body [1]. The incidence of urinary tract infection (UTI) in the renal transplant recipients accounts for 45-72% of all the infections.…”