Böbrek Nakli Hastalarinda Üriner Sistem Enfeksiyonu Gelişimini Etkileyen Risk Faktörleri

Year 2024, , 145 - 160, 31.10.2024

Elif Sevil Alagüney , Şimal Köksal Cevher , Emre Çankaya , Meryem Keleş , Ezgi Yenigun , Nihal Aydemir , Fatih Dede

https://doi.org/10.55517/mrr.1526156

Abstract

Amaç: Son dönem böbrek yetmezliği prevalansı son yıllarda ciddi artış göstermiştir. Bu hastalarda uygulanacak seçkin tedavi biçimi böbrek naklidir. Böbrek nakli yapılan hastalarda üriner sistem enfeksiyonu, sık görülmesi ve mortalite ve morbiditeyi arttırması nedeniyle özel öneme sahiptir. Böbrek nakli hastalarında üriner sistem enfeksiyonu gelişimini etkileyen risk faktörleri ile ilgili yapılan ve farklı sonuçlar elde edilen pek çok araştırma vardır. Bu çalışmada kliniğimizde takip ettiğimiz hastalardaki risk faktörlerini inceleyerek durum tespiti yapmayı ve literatüre katkıda bulunmayı amaçladık. Yöntem: Ankara Numune Eğitim ve Araştırma Hastanesinde böbrek nakli yapılan ve Nefroloji kliniğinde takip edilen 50 hastanın dosyalarını tarayarak retrospektif tipte kesitsel bir çalışma yürüttük. Hasta dosyalarından hastaların üriner sistem enfeksiyonu geçirme durumlarıyla beraber literatürde araştırılmış risk faktörlerini taradık. Her bir risk faktörünün üriner sistem enfeksiyonu gelişimi ile ilişkisi analiz ettik. Bulgular: Çalışmada 19’u kadın, 31’i erkek olan 50 hastanın 22’sinin en az bir kez üriner sistem enfeksiyonu (ÜSE) atağı geçirmiş olduğu görüldü. Nakillerin %52’si canlıdan, %48’i ise kadavradan yapılmıştı. Kadavra donörden yapılan hastalarda ÜSE artmış bulundu (p=0.048). Hastalarda üretral kateter takılı kaldığı süre uzunluğu ile ÜSE gelişiminin arttığı görüldü (p=0.002). Hastaların %32’sinde gecikmiş greft fonksiyonu gelişmişti ve bununla ÜSE gelişimi arasında anlamlı ilişki saptandı (p=0.031). Hastaların %10’nunda akut rejeksiyon atağı mevcuttu ve bu hastalarda ÜSE gelişimi artmış bulundu (p=0,032). Hastaların ortanca soğuk iskemi süresi 420 dakika (17,5 saat) idi ve iskemi süresi artan hastalarda ÜSE gelişimi daha yüksekti (p=0.008). Hastalarda indüksiyon tedavisinde ATG kullanımı ÜSE geçiren hastalarda istatistiksel olarak anlamlı biçimde daha yüksekti (p=0.021). Sonuç: Böbrek nakli hastalarında üriner sistem enfeksiyonu tanısı erkenden konulabilmeli ve etkili olarak tedavi edilmelidir. Üriner sistem enfeksiyonu sıklığını azaltmak için erkenden üriner sistem enfeksiyonuna yol açan risk faktörlerinin bilinmesi ve önlem alınması gerekmektedir.

Keywords

Böbrek nakli, Risk faktörleri, Üriner sistem enfeksiyonu

Ethical Statement

Çıkar çatışması bulunmamaktadır.

Supporting Institution

Destekleyen kurum bulunmamaktadır.

Factors Associated With the Development of Urinary Tract Infection in Renal Transplant Patients

Abstract

Aim: The prevalence of end-stage renal failure has increased significantly in recent years. Kidney transplantation is the treatment of choice in these patients. Urinary tract infection in renal transplant patients is of special importance due to its frequent occurrence and increased mortality and morbidity. There are many studies on the risk factors affecting the development of urinary tract infection in renal transplant patients with different results. In this study, we aimed to analyse the risk factors in patients followed up in our clinic and to contribute to the literature. Method: We conducted a retrospective cross-sectional study by reviewing the files of 50 patients who underwent kidney transplantation and were followed up in the Nephrology clinic of Ankara Numune Training and Research Hospital. From the patient files, we reviewed the patients' urinary tract infection status and the risk factors investigated in the literature. We analysed the relationship between each risk factor and the development of urinary tract infection. Results: In the study, 22 of 50 patients (19 females and 31 males) had at least one episode of urinary tract infection (UTI). Fifty-two per cent of the transplants were from living donors and 48% from cadaveric donors. UTI was found to be increased in cadaveric donor patients (p=0.048). The development of UTI increased with the length of time the urethral catheter was in place (p=0.002). Delayed graft function developed in 32% of the patients and there was a significant correlation between this and development of UTI (p=0.031). Acute rejection episode was present in 10% of the patients and UTI development was found to be increased in these patients (p=0.032). The median duration of cold ischaemia was 420 minutes (17.5 hours) and the development of UTI was higher in patients with increasing duration of ischaemia (p=0.008). The use of ATG in induction therapy was statistically significantly higher in patients with UTI (p=0.021). Conclusion: Urinary tract infection should be diagnosed early and treated effectively in renal transplant patients. In order to reduce the frequency of urinary tract infection, the risk factors leading to urinary tract infection should be known early and precautions should be taken.

Keywords

Kidney transplantation, Risk factors, Urinary tract infection

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