Risk factors for urinary tract infections in renal allograft recipients: Experience of a tertiary care center in Hyderabad, South India

Mohan, Midhun; Neeraja, M.; Sudhaharan, Sukanya; Raju, Sree Bhushan; Gangadhar, Tara C.; Lakshmi, V

doi:10.4103/ijn.ijn_331_16

Cited by 13 publications

(3 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although most common infectious bacteria after renal transplant are documented to be Escherichia coli , the most common indication to use colistin in our cohort was Klebsiella pneumoniae . 30,31 Colistin resistance was observed in 2/82 (2.43%) of our solid organ transplant recipients as is seen in many other published series. 32,33 Most infections in the liver group were of bloodstream origin.…”

Section: Discussionsupporting

confidence: 82%

Colistin (Polymyxin E) Use in Abdominal Solid Organ Transplant Recipients

Krishnakumar

Asok

Mohamed

et al. 2022

Journal of Pharmacy Practice

View full text Add to dashboard Cite

Background: Patients undergoing solid organ transplantation are at a higher risk of multi-drug resistant (MDR) bacterial infections especially during the immediate post operative period. Objective: To audit the usage, dosage appropriateness and safety of colistin use in abdominal solid organ transplant recipients to treat immediate post-transplant bacterial infections. Methods: After completion of 1000 abdominal solid organ transplants at our institute, data of the transplant recipients who received colistin between October 2010 and December 2019 was extracted from the hospital health information system. Data of all microbiological culture isolates, the minimum inhibitory concentration (MIC) of colistin, appropriateness of colistin dosing and nephrotoxicity associated with colistin use was assessed. Results: Of the 1170 (732 liver and 438 renal) solid organ transplant recipients, 82 (66 liver and 16 renal) received colistin to treat posttransplant MDR bacterial infections. Nearly 60% received colistin as definitive therapy and 87.81% received colistin as combination. Mean duration of colistin therapy was found to be higher in renal than liver transplant recipients. Out of the total 89 bacterial isolates, there were 2 colistin resistant Klebsiella strains. Colistin in combination with meropenem (36.4%) was the most commonly used dual therapy. Out of the total 89 bacterial isolates, there were 2 colistin resistant Klebsiella strains. Overall in-hospital mortality of patients who received colistin was 43.9%. Renal impairment occurred in 28.8% of liver transplant recipients. Conclusion: Infection necessitating colistin use increases mortality by three folds in liver transplant recipients and by five percentage points in renal transplant recipients.

show abstract

Section: Discussionsupporting

confidence: 82%

Colistin (Polymyxin E) Use in Abdominal Solid Organ Transplant Recipients

Krishnakumar

Asok

Mohamed

et al. 2022

Journal of Pharmacy Practice

View full text Add to dashboard Cite

show abstract

“…Several risk factors were identified and are thought to increase the risk of UTIs after renal transplant. These include older age, female gender, diabetes, history of acute rejection [ 2 ], delayed graft function [ 4 ], deceased donor kidney transplantation, longer duration of dialysis [ 5 ], and urological abnormalities [ 3 ]. Timing of stent removal and the use of antibiotic prophylaxis are important modifying factors.…”

Section: Introductionmentioning

confidence: 99%

Urinary Tract Infections in the First 6 Months after Renal Transplantation

Arabi

Thiab

Altheaby

et al. 2021

International Journal of Nephrology

View full text Add to dashboard Cite

Purpose. Urinary tract infections (UTIs) are common in the first 6 months after renal transplantation, and there are only limited data about UTIs after transplantation in Saudi Arabia in general. Methods. A retrospective study from January 2017 to May 2020 with 6-month follow-up. Results. 279 renal transplant recipients were included. Mean age was 43.4 ± 16.0 years, and114 (40.9%) were women. Urinary stents were inserted routinely during transplantation and were removed 35.3 ± 28 days postoperatively. Ninety-seven patients (35%) developed urinary tract infections (UTIs) in the first six months after renal transplantation. Of those who developed the first episode of UTI, the recurrence rates were 57%, 27%, and 14% for having one, two, or three recurrences, respectively. Late urinary stent removals, defined as more than 21 days postoperatively, tended to have more UTIs (OR: 1.43, P: 0.259, CI: 0.76–2.66). Age >40, female gender, history of neurogenic bladder, and transplantation abroad were statistically significant factors associated with UTIs and recurrence. Diabetes, level of immunosuppression, deceased donor renal transplantation, pretransplant residual urine volume, or history of vesicoureteral reflux (VUR) was not associated with a higher incidence of UTIs. UTIs were asymptomatic in 60% but complicated with bacteremia in 6% of the cases. Multidrug resistant organisms (MDROs) were the causative organisms in 42% of cases, and in-hospital treatment was required in about 50% of cases. Norfloxacin + Bactrim DD (160/800 mg) every other day was not associated with the lower risk of developing UTIs compared to the standard prophylaxis daily Bactrim SS (80/400 mg). Conclusion. UTIs and recurrence are common in the first 6 months after renal transplantation. Age >40, female gender, neurogenic bladder, and transplantation abroad are associated with the increased risk of UTIs and recurrence. MDROs are common causative organisms, and hospitalization is frequently required. Dual prophylactic antibiotics did not seem to be advantageous over the standard daily Bactrim.

show abstract

“…While the opportunity for employment continues to be a perceived advantage of PD (compared with HD), patients may view “maintain or apply for a job” as a disadvantage if they are comparing this with employment prior to starting dialysis (vs. what employment while on HD was or would be like), or perhaps if the ability to “maintain or apply for a job” did not live up to their expectations of the freedom they were counseled to expect with PD. While the loss of employment has been shown to be similar after initiation of HD or PD [25], studies have also shown a significantly higher loss of employment with HD, compared with PD [26]. However, any type of dialysis is likely to be somewhat restrictive, and the benefit of maintaining or applying for a job while on PD may be more of a theoretical advantage.…”

Section: Discussionmentioning

confidence: 99%

Patient-reported advantages and disadvantages of peritoneal dialysis: results from the PDOPPS

et al. 2019

View full text Add to dashboard Cite

Background Patient-reported measures are increasingly recognized as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand associations between patient-reported perceptions of the advantages and disadvantages of PD and clinical outcomes. Methods In this cohort study, 2760 PD patients in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) completed a questionnaire on their PD experience, between 2014 and 2017. In this questionnaire, PDOPPS patients rated 17 aspects of their PD experience on a 5-category ordinal scale, with responses scored from − 2 (major disadvantage) to + 2 (major advantage). An advantage/disadvantage score (ADS) was computed for each patient by averaging their response scores. The ADS, along with each of these 17 aspects, were used as exposures. Outcomes included mortality, transition to hemodialysis (HD), patient-reported quality of life (QOL), and depression. Cox regression was used to estimate associations between ADS and mortality, transition to HD, and a composite of the two. Logistic regression with generalized estimating equations was used to estimate cross-sectional associations of ADS with QOL and depression. Results While 7% of PD patients had an ADS < 0 (negative perception of PD), 59% had an ADS between 0 and < 1 (positive perception), and 34% had an ADS ≥1 (very positive perception). Minimal association was observed between mortality and the ADS. Compared with a very positive perception, patients with a negative perception had a higher transition rate to HD (hazard ratio [HR] = 1.67; 95% confidence interval [CI]: 1.21, 2.30). Among individual items, “space taken up by PD supplies” was commonly rated as a disadvantage and had the strongest association with transition to HD (HR = 1.28; 95% CI 1.07, 1.53). Lower ADS was strongly associated with worse QOL rating and greater depressive symptoms. Conclusions Although patients reported a generally favorable perception of PD, patient-reported disadvantages were associated with transition to HD, lower QOL, and depression. Strategies addressing these disadvantages, in particular reducing solution storage space, may improve patient outcomes and the experience of PD. Electronic supplementary material The online version of this article (10.1186/s12882-019-1304-3) contains supplementary material, which is available to authorized users.

show abstract

Risk factors for urinary tract infections in renal allograft recipients: Experience of a tertiary care center in Hyderabad, South India

Cited by 13 publications

References 29 publications

Colistin (Polymyxin E) Use in Abdominal Solid Organ Transplant Recipients

Colistin (Polymyxin E) Use in Abdominal Solid Organ Transplant Recipients

Urinary Tract Infections in the First 6 Months after Renal Transplantation

Patient-reported advantages and disadvantages of peritoneal dialysis: results from the PDOPPS

Contact Info

Product

Resources

About