Böbrek Nakli Hastalarinda Üriner Sistem Enfeksiyonu Gelişimini Etkileyen Risk Faktörleri

Year 2024, Volume: 7 Issue: 3, 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

References

• National Kidney F. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis. 2002;39(2 Suppl 1):S1-266.
• Levey AS, Eckardt KU, Tsukamoto Y, Levin A, Coresh J, Rossert J, et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2005;67(6):2089-100.
• Suleymanlar G, Utas C, Arinsoy T, Ates K, Altun B, Altiparmak MR, et al. A population-based survey of Chronic REnal Disease In Turkey--the CREDIT study. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2011;26(6):1862-71.
• Gomez CG, Valido P, Celadilla O, Bernaldo de Quiros AG, Mojon M. Validity of a standard information protocol provided to end-stage renal disease patients and its effect on treatment selection. Perit Dial Int. 1999;19(5):471-7.
• Suthanthiran M, Strom TB. Renal transplantation. N Engl J Med. 1994;331(6):365-76.
• Papadakis M.A. MSJ. Current Medical Diagnosis and Treatment: Mc-Graw Hill Companies; 2013.
• Schrier RW. Manual of Nephrology: Lippincott Williams & Wilkins; 2009.
• KDIGO Clinical Practice Guideline for the Care of Kidney Transplant Recipients. American Journal of Transplantation. 2009 Nov;9:S1–155.
• Lerma E. V. BJS, Nissenson A. R. Current Diagnosis and Treatment: Nephrology & Hypertension: Mc-Graw Hill Companies; 2009.
• Rubin RH. Infectious disease complications of renal transplantation. Kidney Int. 1993;44(1):221-36.
• Rubin RH, Wolfson JS, Cosimi AB, Tolkoff-Rubin NE. Infection in the renal transplant recipient. Am J Med. 1981;70(2):405-11.
• Lyerova L, Lacha J, Skibova J, Teplan V, Vitko S, Schuck O. Urinary tract infection in patients with urological complications after renal transplantation with respect to long-term function and allograft survival. Ann Transplant. 2001;6(2):19-20.
• Aguado JM, Salto E, Morales JM, Munoz MA, Lizasoain M, Lumbreras C, et al. Corynebacterium urealyticum: a new and threatening pathogen for the renal transplant patient. Transplant Proc. 1993;25(1 Pt 2):1493-4.
• Domann E, Hong G, Imirzalioglu C, Turschner S, Kuhle J, Watzel C, et al. Culture-independent identification of pathogenic bacteria and polymicrobial infections in the genitourinary tract of renal transplant recipients. J Clin Microbiol. 2003;41(12):5500-10.
• Wilson CH, Rix DA, Manas DM. Routine intraoperative ureteric stenting for kidney transplant recipients. Cochrane Database Syst Rev. 2013;6:CD004925.
• de Souza RM, Olsburgh J. Urinary tract infection in the renal transplant patient. Nat Clin Pract Nephrol. 2008;4(5):252-64.
• Muller V, Becker G, Delfs M, Albrecht KH, Philipp T, Heemann U. Do urinary tract infections trigger chronic kidney transplant rejection in man? J Urol. 1998;159(6):1826-9.
• Schmaldienst S, Dittrich E, Horl WH. Urinary tract infections after renal transplantation. Curr Opin Urol. 2002;12(2):125-30.
• Dupont PJ, Psimenou E, Lord R, Buscombe JR, Hilson AJ, Sweny P. Late recurrent urinary tract infections may produce renal allograft scarring even in the absence of symptoms or vesicoureteric reflux. Transplantation. 2007;84(3):351-5.
• Camargo LF, Esteves AB, Ulisses LR, Rivelli GG, Mazzali M. Urinary tract infection in renal transplant recipients: incidence, risk factors, and impact on graft function. Transplant Proc. 2014;46(6):1757-9.
• Lim JH, Cho JH, Lee JH, Park YJ, Jin S, Park GY, et al. Risk factors for recurrent urinary tract infection in kidney transplant recipients. Transplant Proc. 2013;45(4):1584-9.
• Barbouch S, Cherif M, Ounissi M, Karoui C, Mzoughi S, Hamida FB, et al. Urinary tract infections following renal transplantation: a single-center experience. Saudi J Kidney Dis Transpl. 2012;23(6):1311-4.
• Abbott KC, Swanson SJ, Richter ER, Bohen EM, Agodoa LY, Peters TG, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis. 2004;44(2):353-62.
• Fiorante S, Fernandez-Ruiz M, Lopez-Medrano F, Lizasoain M, Lalueza A, Morales JM, et al. Acute graft pyelonephritis in renal transplant recipients: incidence, risk factors and long-term outcome. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2011;26(3):1065-73.
• Takai K, Aoki A, Suga A, Tollemar J, Wilczek HE, Naito K, et al. Urinary tract infections following renal transplantation. Transplant Proc. 1998;30(7):3140-1.
• Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant. 2005;19(2):230-5.
• Erturk E, Burzon DT, Orloff M, Rabinowitz R. Outcome of patients with vesicoureteral reflux after renal transplantation: the effect of pretransplantation surgery on posttransplant urinary tract infections. Urology. 1998;51(5A Suppl):27-30.
• Stamm WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. The American journal of medicine. 1991;91(3B):65S-71S.
• Dantas SR, Kuboyama RH, Mazzali M, Moretti ML. Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect. 2006;63(2):117-23.
• Wilson CH, Bhatti AA, Rix DA, Manas DM. Routine intraoperative ureteric stenting for kidney transplant recipients. The Cochrane database of systematic reviews. 2005(4):CD004925.
• Ranganathan M, Akbar M, Ilham MA, Chavez R, Kumar N, Asderakis A. Infective complications associated with ureteral stents in renal transplant recipients. Transplant Proc. 2009;41(1):162-4.
• Yacoub R, Akl NK. Urinary tract infections and asymptomatic bacteriuria in renal transplant recipients. J Glob Infect Dis. 2011;3(4):383-9.
• Gavela Martinez E, Pallardo Mateu LM, Sancho Calabuig A, Beltran Catalan S, Kanter Berga J, Avila Bernabeu AI, et al. Delayed graft function after renal transplantation: an unresolved problem. Transplant Proc. 2011;43(6):2171-3.
• Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006;20(4):401-9.
• Papasotiriou M, Savvidaki E, Kalliakmani P, Papachristou E, Marangos M, Fokaefs E, et al. Predisposing factors to the development of urinary tract infections in renal transplant recipients and the impact on the long-term graft function. Ren Fail. 2011;33(4):405-10.
• Goya N, Tanabe K, Iguchi Y, Oshima T, Yagisawa T, Toma H, et al. Prevalence of urinary tract infection during outpatient follow-up after renal transplantation. Infection. 1997;25(2):101-5.
• Veroux M, Giuffrida G, Corona D, Gagliano M, Scriffignano V, Vizcarra D, et al. Infective complications in renal allograft recipients: epidemiology and outcome. Transplantation proceedings. 2008;40(6):1873-6.
• Sousa SR, Galante NZ, Barbosa DA, Pestana JO. [Incidence of infectious complications and their risk factors in the first year after renal transplantation]. J Bras Nefrol. 2010;32(1):75-82.
• Memikoglu KO, Keven K, Sengul S, Soypacaci Z, Erturk S, Erbay B. Urinary tract infections following renal transplantation: a single-center experience. Transplant Proc. 2007;39(10):3131-4.