Asymptomatic Bacteriuria & Risk of Urinary Tract Infection in Renal Transplants

无症状菌尿

基本信息

  • 批准号:
    8055156
  • 负责人:
  • 金额:
    $ 27.77万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2009
  • 资助国家:
    美国
  • 起止时间:
    2009-09-21 至 2011-08-31
  • 项目状态:
    已结题

项目摘要

DESCRIPTION (provided by applicant): Asymptomatic bacteriuria (ASB) is the isolation of a specified quantity of bacteria from a person without symptoms or signs referableto urinary infection. ASB is common in women and increases with advancing age. There is some evidence that treatment of ASB does not prevent symptomatic urinary tract infection (UTI) and may actually lead to an increased incidence of uropathogen antibiotic resistance with a higher likelihood of complications. Questions remain as to incidence of ASB in the renal transplant recipient and whether certain virulence factors expressed on uropathic bacteria facilitate symptomatic UTI or acute renal allograft injury. In preliminary retrospective studies, we found that the majority of renal transplant patients with E. coli UTI are asymptomatic. Despite the lack of UTI symptoms, some renal transplant patients with ASB develop cystitis, pyelonephritis or acute kidney injury. The majority of the bacterial isolates from ASB patients with renal allograft injury express uropathic P fimbriae, an adhesin molecule that facilitates bacterial attachment to the uro-epithelium and may contribute to an injurious inflammatory immune response. In addition, the urinary isolates from renal transplant patients with E. coli ASB are frequently resistant to common antimicrobial agents used to treat UTI. We propose to determine the prevalence of ASB in renal transplant patients and to identify the host characteristics and bacterial virulence factors expressed on ASB isolates that facilitate the develop of symptomatic UTI. Identifying isolates from patients with ASB that express uropathogenic factors will limit inappropriate antibiotic use and decrease the deleterious effects of UTI on renal allograft function. The ultimate goal of this line of research is to determine if screening and treatment of ASB prevents symptomatic UTI and prevents renal allograft injury. Data from this R21 pilot grant will be the background for the design of a multi-center clinical trial of ASB in the renal transplant patient. Information from this trial would lead to a much needed screening and treatment guidelines for ASB in the renal transplant population. PUBLIC HEALTH RELEVANCE: Urinary tract infections (UTIs) are the most common infection in the kidney transplant patient and are associated with a poor kidney graft and patient survival. It is unclear if asymptomatic UTI, or asymptomatic bacteriuria (ASB), is associated with the development of symptomatic UTI or graft dysfunction in the renal transplant patient. Recent guidelines from the Infectious Disease Society of American (IDSA) acknowledge that "no recommendations can be made for or against screening or treatment of ASB in renal transplant patients". Studies are needed to determine the prevalence of ASB and the host characteristics, bacterial virulence factors and consequences associated with ABU in the renal transplant patient.
描述(由申请人提供):无症状菌尿(ASB)是指从没有泌尿道感染相关症状或体征的人体内分离出指定数量的细菌。 ASB 在女性中很常见,并且随着年龄的增长而增加。有一些证据表明,ASB 治疗并不能预防症状性尿路感染 (UTI),实际上可能会导致尿路病原体抗生素耐药性发生率增加,并增加出现并发症的可能性。关于肾移植受者中 ASB 的发生率以及尿路病细菌表达的某些毒力因子是否会促进症状性尿路感染或急性同种肾移植损伤,仍存在疑问。在初步回顾性研究中,我们发现大多数患有大肠杆菌UTI的肾移植患者没有症状。尽管没有尿路感染症状,但一些患有 ASB 的肾移植患者会出现膀胱炎、肾盂肾炎或急性肾损伤。大多数来自肾同种异体移植损伤 ASB 患者的细菌分离物表达尿路病性 P 菌毛,这是一种粘附素分子,可促进细菌附着在尿路上皮上,并可能导致有害的炎症免疫反应。此外,肾移植患者的尿液中分离出的大肠杆菌 ASB 通常对治疗尿路感染的常见抗菌药物具有耐药性。我们建议确定肾移植患者中 ASB 的患病率,并确定 ASB 分离株表达的宿主特征和细菌毒力因子,以促进症状性 UTI 的发展。鉴定来自 ASB 患者的表达尿路致病因子的分离株将限制抗生素的不当使用,并减少 UTI 对肾同种异体移植功能的有害影响。这一系列研究的最终目标是确定 ASB 的筛查和治疗是否可以预防症状性尿路感染并预防同种异体移植肾损伤。 R21 试点资助的数据将成为设计肾移植患者 ASB 多中心临床试验的背景。该试验的信息将导致肾移植人群中急需的 ASB 筛查和治疗指南。公众健康相关性:尿路感染 (UTI) 是肾移植患者最常见的感染,与肾移植效果不佳和患者生存相关。目前尚不清楚无症状尿路感染或无症状菌尿 (ASB) 是否与肾移植患者出现症状性尿路感染或移植物功能障碍有关。美国传染病学会 (IDSA) 最近的指南承认,“不能提出支持或反对肾移植患者进行 ASB 筛查或治疗的建议”。需要进行研究来确定肾移植患者中 ASB 的患病率以及宿主特征、细菌毒力因素以及与 ABU 相关的后果。

项目成果

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James Carter Rice其他文献

James Carter Rice的其他文献

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{{ truncateString('James Carter Rice', 18)}}的其他基金

Asymptomatic Bacteriuria & Risk of Urinary Tract Infection in Renal Transplants
无症状菌尿
  • 批准号:
    7589592
  • 财政年份:
    2009
  • 资助金额:
    $ 27.77万
  • 项目类别:

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