Frequency and Characteristics of Infections in Kidney Transplant Recipients

Yıl 2020, , 34 - 40, 30.08.2020

Aslı Karadeniz

https://doi.org/10.35514/mtd.2020.27

Öz

Objective: Infectious complications after kidney transplantation are important causes of morbidity. In this study, it was aimed to examine the post-transplantation infections and their characteristics in kidney transplant patients. Materials and Methods: 91 patients (71 living, 20 cadaveric) transplanted between January 2005 and December 2006 in Istanbul Medical Faculty Hospital were evaluated retrospectively until December 2007 (mean duration of 23.4±7.4 months). Results: The infection rate detected in kidney transplant recipients was 48.4%. Intensive immunosuppressive therapy, broad-spectrum and long-term perioperative prophylaxis, and prolonged urinary catheterization in patients who received organs from cadavers attracted attention, and the incidence of infection in these patients (70%) was found to be higher than those who received organs from living organs (42.25%). . When evaluated according to the infection time calendar, the highest number of infections was observed in the posttransplantation period between 1-6 months (43%). Urinary system infections were the most common infection (68.6%) in all periods, followed by pneumonia (14%) and surgical site infections (9.3%). Other rare infections are cytomegalovirus infection (n=2), herpes zoster (n=2), candidemia (n=1), and tuberculous epididymoorchitis (n=1). While bacterial infections are the most common, Pseudomonas aeruginosa and Escherichia coli are the most common agents. Conclusion: Despite all the advances in immunosuppression therapy and surgical techniques in kidney transplantation, infections are still an important problem and it would be best to follow pre-transplant evaluation and post-transplant prevention and control measures.

Anahtar Kelimeler

kidney, transplantation, infection

Böbrek Transplantı Alıcılarında Görülen İnfeksiyonların Sıklığı ve Özellikleri

Öz

Amaç: Böbrek transplantasyonu sonrası infeksiyöz komplikasyonlar önemli morbidite nedenidir. Çalışmada böbrek transplantasyonu yapılan hastalarda transplantasyon sonrası gelişen infeksiyonları ve özelliklerini incelemek amaçlanmıştır.
Materyal ve Metod: İstanbul Tıp Fakültesi Hastanesinde, Ocak 2005-Aralık 2006 tarihleri arasında transplantasyon yapılan 91 hasta (71’ i canlı, 20’ si kadavradan) Aralık 2007 tarihine dek (ortalama 23.4±7.4 ay süreyle), retrospektif olarak değerlendirilmiştir.
Bulgular: Böbrek transplantı alıcılarında saptanan infeksiyon oranı % 48.4’dir. Kadavradan organ alan hastalarda yoğun immünosüpresif tedavi, geniş spektrumlu ve uzun süreli uygulanan perioperatif profilaksi ve idrar sondasının uzun süre kalması gibi infeksiyon riski taşıyan uygulamalar dikkat çekmiş ve bu hastalarda infeksiyon sıklığı (% 70), canlıdan organ alanlara (% 42.25) göre daha yüksek bulunmuştur. İnfeksiyon zaman takvimine göre değerlendirildiğinde, posttransplantasyon dönemde en fazla infeksiyon 1-6 ay arası dönemde (% 43) görülmüştür. Üriner sistem infeksiyonları tüm dönemlerde en sık (% 68.6) saptanan infeksiyon olup bunu pnömoni (% 14) ve cerrahi alan infeksiyonları (% 9.3) izlemiştir. Sitomegalovirus infeksiyonu (n=2), herpes zoster (n=2), kandidemi (n=1) ve tüberkülöz epididimoorşit (n=1) diğer nadir infeksiyonlardır. Bakteriyel infeksiyonlar en sık saptanırken, Pseudomonas aeruginosa ve Escherichia coli en sık etkenlerdir.
Sonuç: Böbrek transplantasyonunda immünosüpresyon tedavisi ve cerrahi tekniklerde elde edilen tüm gelişmelere rağmen, infeksiyonlar hâlâ önemli bir problemdir ve transplantasyon öncesi değerlendirme ve transplantasyon sonrası koruma ve kontrol önlemlerine uymak en iyi yaklaşım olacaktır.

Anahtar Kelimeler

böbrek, transplantasyon, infeksiyon

Kaynakça

• KAYNAKLAR 1) Stitt NL. Infection in the Transplant Recipient. Organ Transplant 2003 © 2003 Medscape.
• 2) Villacian JS, Paya CV. Prevention of infections in solid organ transplant recipients. Tranpl Infect Dis 1999; 1: 50-64
• 3) Bloom RD, Goldberg LR, Wang AY. An overview of solid organ transplantation. Clin Chest Med 2005; 26(4): 529-43
• 4) Matas AJ, Payne WD, Sutherland DE, Humar A, Gruessner RW, Kandaswamy R et al. 2,500 living donor kidney transplants: a single-center experience. Ann Surg 2001; 234(2): 149-64
• 5) Patel R, Paya CV. Infections in solid-organ transplant recipients. Clin Microbiol Rev 1997; 10: 86-124 6) Prasad SA, Kasiske BL, Curtis JJ, Gober O, Rubin RH, Woodle Es et al. Infectious complications posttransplantation 2005; http://www.medscape.com/viewprogram/4392
• 7) Rubin RH, Ikonen T, Gummert JF, Morris RE. The therapeutic prescription for the organ transplant recipient: the linkage of immunosuppression and antimicrobial strategies. Tranpl Infect Dis 1999; 1: 29-39
• 8) Pourmand G, Salem S, Mehrsai A, Taherimahmoudi M, Ebrahimi R, Pourmand MR. Infectious complications after kidney transplantation: a single-center experience. Transplant Infect Dis 2007; 9; 302-9
• 9) Ness D, Olsburg J. UTI in kidney transplant. World J Urol. 2020 Jan;38:81-8.
• 10) 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: 117-23
• 11) Ferraresso M, Berardinelli L. Nosocomial infection in kidney transplant recipients: a retrospective analysis of a single-center experience. Transplant Proc 2005; 37: 2495-6
• 12) Charfeddine K, Zaghden S, Kharrat M, Kamoun K, Jarraya F, Hachicha J. Infectious complications in kidney transplant recipients: a single-center experience. Transplant Proc 2005; 37: 2823-5
• 13) Safdar N, Slattery WR, Knasinski V, Gangnon RE, Li Z, et al. Predictors and outcomes of candiduria in renal transplant recipients. Clin Infect Dis 2005; 40: 1413-21
• 14) Sharma M, Rani S, Johnson LB. Effect of time after transplantation on microbiology of urinary tract infections among renal transplant recipients. Transplant Infect Dis 2008; 10; 145-8
• 15) Trzeciak S, Sharer R, Piper D, Chan T, Kessler C, Dellinger R et al. Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED. Am J Emerg Med 2004; 22: 530-3
• 16) Munoz P. Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis 2001; 33: 53-7 17) Takai K, Aoki A, Suga A, Tollemar J, Wilczek HE, Naito K et al. Urinary tract infections following renal transplantation. Transplant Proc 1998; 30: 3140-1
• 18) Veroux M, Giuffrida G, Corona D, Gagliano M, Scriffignano V, Vizcarra D et al. Infective complications in renal allograft recipients: epidemiology and outcome. Transplant Proc 2008; 40:1873-6 19) Anonymous. Introduction to the guidelines (Editorial). Am J Transplant 2004; 4: 6-9
• 20) Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis 2002; 34(8):1094-7 21) Cervera C, Agusti C, Angeles Marcos M, Pumarola T, Cofan F, Navasa M et al. Microbiologic features and outcome of pneumonia in transplanted patients. Diagn Microbiol Infect Dis 2006; 55: 47-54
• 22) Sinha S, Jha R, Narayan G, Bhaskar BV, Rayudu RS, Hemlatha K, et al. Pulmonary infections after kidney transplantation: impact of prophylaxis. Transplant Proc 2003; 35: 287-8
• 23) Gourishankar S, McDermid JC, Jhangri GS, Preiksaitis JK. Herpes zoster infection following solid organ transplantation: incidence, risk factors and outcomes in the current immunosuppressive era. Am J Transplant 2004; 4: 108-15
• 24) Avery RK, Michaels M. Update on immunizations in solid organ transplant recipients: what clinicians need to know. Am J Transplant 2008; 8: 9-14
• 25) Ergun I, Ekmekci Y, Sengul S, Kutlay S, Dede F, Canbakan F et al. Mycobacterium tuberculosis infection in renal transplant recipients. Transplant Proc 2006; 38: 1344-5