Effects of recurrent urinary tract infections on graft and patient outcomes after kidney transplantation
Effects of recurrent urinary tract infections on graft and patient outcomes after kidney transplantation
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DOI：
10.1093/ndt/gfx237
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发表时间：
2017-10-01
影响因子：
6.1
通讯作者：
Horwedel, Timothy A.
中科院分区：
文献类型：
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作者：
Britt, Nicholas S.;Hagopian, Jennifer C.;Horwedel, Timothy A.
背景资料。尿路感染(UTI)是肾移植(KT)后常见的并发症，但对KT后复发的尿路感染(R-UTI)的影响尚不清楚。我们在巴恩斯-犹太医院(圣路易斯，密苏里州)进行了一项回顾性队列研究，比较了无尿路感染、未复发尿路感染(NR-UTI)(尿样中含有10(5)个细菌集落形成单位/毫升)和R-UTI(任何6个月内2个尿路感染或任何12个月内3个尿路感染)患者的移植物结局、患者结局和多重耐药率。研究对象包括所有接受KT的成人患者，不包括KT后30天内死亡的患者。在纳入的2469例受者中，1835例(74.3%)无尿路感染，465例(18.8%)有NR-UTI，169例(6.8%)有R-UTI。与NR-UTI相比，R-UTI的移植物存活率较差[风险比(HR)1.45；95%可信区间(CI)1.23-1.83；P<；0.001]和无UTI(HR 2.11；95%CI 2.02-3.80；P<；0.001)。在COX回归中调整混杂因素后，这种关系仍然存在(HR2.01；95%CI1.53-2.66；P<；0.001)。未发生尿路感染患者与非复发组患者的生存率差异无统计学意义(HR1.21；95%CI0.91~1.63；P=0.181)，但与未复发者相比，RUTI患者的生存率较差(HR1.87；95%CI1.21~2.89；P=0.005)。耐药革兰氏阴性菌感染更易发生(风险比1.49；95%可信区间1.31~1.70；P<；0.001)。与非复发病例相比，R-UTIs与较差的移植物和患者预后以及增加的多药耐药性有关。
Background. Urinary tract infections (UTIs) are common following kidney transplantation (KT); however, the influence of recurrent post-KT UTI (R-UTI) is not well-characterized.Methods. We compared graft outcomes, patient outcomes and multidrug-resistance rates between patients with no UTI, nonrecurrent UTI (NR-UTI) (urine sample containing > 10(5) bacterial colony-forming units/mL) and R-UTI (>= 2 UTIs in any 6-month period or >= 3 UTIs in any 12-month period) post-KT in a retrospective cohort study (1999-2014) at Barnes-Jewish Hospital (St Louis, MO). All adult KT recipients were included and those experiencing mortality within 30 days of KT were excluded.Results. Of 2469 recipients included, 1835 (74.3%) had no UTI, 465 (18.8%) had NR-UTI and 169 (6.8%) had R-UTI. R-UTI was associated with poorer graft survival compared with NR-UTI [hazard ratio (HR) 1.45; 95% confidence interval (CI) 1.23-1.83; P < 0.001) and no UTI (HR 2.11; 95% CI 2.02-3.80; P < 0.001). This relationship persisted after adjusting for confounding factors in Cox regression (HR 2.01; 95% CI 1.53-2.66; P < 0.001). There was no difference in patient survival between no UTI and NR-UTI (HR 1.21; 95% CI 0.91-1.63; P = 0.181); however, R-UTI was associated with poorer patient survival compared with nonrecurrent cases (HR 1.87; 95% CI 1.21-2.89; P = 0.005). R-UTI were more likely to be caused by multidrug-resistant Gram-negative organisms (risk ratio 1.49; 95% CI 1.31-1.70; P < 0.001).Conclusions. R-UTIs were associated with poorer graft and patient outcomes, as well as increased multidrug-resistance compared with nonrecurrent cases.