Renal transplant sonrası iki yıllık izlemde gelişen üriner sistem enfeksiyonlarının değerlendirilmesi: tek merkez deneyimi

Öz

Giriş: Renal transplantasyon sonrası, %23-75 oranında üriner sistem enfeksiyonu (ÜSE) görülmektedir. Bu çalışmada böbrek nakli sonrası ÜSE sıklığı, neden olan patojenler ve riski artıran predispozan faktörlerin araştırılması amaçlanmıştır.
Hastalar ve metod: 2016-2017 yılları arasında hastanemizde renal transplant yapılan hastalar çalışmaya dahil edildi. Postoperatif immunsupresif tedavileri; basiliksimab, mikofenolat mofetil, takrolimus ve prednizolon kombinasyonundan oluştu. Perioperatif antibiyotik profilaksisinde bir hastada klindamisin, diğerlerinde sefuroksim aksetil kullanıldı. Tüm hastalara üriner kateterizasyon ve anastomoz esnasında double- J stend kullanıldı. Hastalara postoperatif dönemde 6 ay boyunca Pneumocystis jirovecii profilaksisi için trimetoprim sulfametaksazol (TMP-SXT) verildi.
Bulgular: Böbrek transplantasyonu yapılan 25 hasta çalışmaya dahil edildi. On iki hastada (%48) ÜSE saptandı. Bir hastada nörojenik mesane, üçünde nefrolitiyazis ve birinde vezikoüreteral reflü mevcuttu. Hastaların 8’inde en az iki ÜSE atağı mevcuttu. Toplam 38 ÜSE atağında; 7 (%18,4) nitrit pozitifliği saptandı. 15’inde (%39,5) transplantasyon sonrası ilk 3 ay içerisinde ÜSE saptandı. İdrar kültürlerinin 7’sinde (%18,4) gram pozitif, 27’sinde (%71,1) gram negatif bakteri üremesi olurken, 4’ü (%10,5) kontaminasyon olarak bulundu. Üreyen etkenler arasında Escherichia coli (%34,2) ilk sırada yer alırken, bunu sırasıyla Klebsiella pneumoniae (%21,1), Enterococcus faecium (%18,4), Pseudomonas aeruginosa (%5,3) ve diğer gram negatif (%10,5) üropatojenlerin izlediği bulundu. ÜSE öncesi bazal ve ÜSE sırasındaki GFR (glomerüler filtrasyon hızı) düzeyleri karşılaştırıldığında ÜSE sırasında saptanan GFR değerlerinin öncesine göre anlamlı derecede azaldığı saptandı (p=0.00) ÜSE tedavisinde en sık tercih edilen antibiyotikler ertapenem %42,1, levofloksasin %10,5, seftriakson %10,5 ve fosfomisin %10,5 idi.
Sonuç: Transplant alıcılarında profilaksi ve tedavi amaçlı antibiyotiklerin kullanımına bağlı üropatojenlerin direnç oranları artmaktadır. Uygunsuz tedavi edilen ÜSE, transplantasyonun sonucunu olumsuz etkilemekte ve mortaliteyi arttırmaktadır. Bu yüzden hastaların risk faktörleri, antibiyotik dirençleri, ampirik tedaviler gözden geçirilmeli ve tedavi başarısının arttırılması sağlanmalıdır.

Anahtar Kelimeler

• transplant
• ÜSE
• Renal transplant
• transplant
• ÜSE
• Renal transplant, transplant, ÜSE

Evaluation of urinary tract infections in a two-year follow-up after renal transplantation: a single center experience

Öz

Introduction: After renal transplantation, urinary tract infection (UTI) is observed in 23-75% of cases. In this study, we aimed to investigate the incidence of UTIs after renal transplantation, the causative pathogens and the predisposing factors that increase the risk.
Methodology: Patients who underwent renal transplantation in our hospital between 2016-2017 were included in the study.
Results: Twenty-five patients who underwent kidney transplantation were included in the study. UTI was detected in 12 patients (48%). One patient had neurogenic bladder, three had nephrolithiasis and one had vesicoureteral reflux. 8 of the patients had at least two UTI attacks. In total 38 UTI attacks; There were 7 (18.4%) nitrite positivity. UTI was detected in 15 (39.5%) patients during the first 3 months after transplantation. While 7 (18.4%) of the urine cultures were gram positive and 27 (71.1%) were gram negative bacteria, 4 (10.5%) were found as contamination. Escherichia coli (34.2%) was the most common causative agent, followed by Klebsiella pneumoniae (21.1%), Enterococcus faecium (18.4%), Pseudomonas aeruginosa (5.3%) and other gram negative (%). 10.5 uropathogens were found to be followed. When compared with basal and UTI GFR (glomerular filtration rate) levels, the GFR values detected during UTI were decreased significantly (p=0.00). The most frequently preferred antibiotics in UTI treatment were ertapenem 42.1%, levofloxacin 10.5%, seftriaxon 10.5% and fosfomycin 10.5%.
Conclusion: Improperly treated UTI negatively affects the outcome of transplantation and increases mortality. Therefore, risk factors, antibiotic resistance and empirical treatments should be reviewed and treatment success should be increased.

Anahtar Kelimeler

• Renal transplantation
• transplantation
• UTI

Kaynakça

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