Asymptomatic Bacteriuria & Risk of Urinary Tract Infection in Renal Transplants

无症状菌尿

• 批准号: 7589592
• 负责人: James Carter Rice
• 金额: --
• 依托单位: UNIVERSITY OF TEXAS MED BR GALVESTON
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-21 至 2009-10-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7589592
• 关键词: Acute; Acute Kidney Failure; Acute Renal Failure with Renal Papillary Necrosis; Allografting; American; Antibiotic Resistance; Antibiotics; Antigens; Bacteria; Bacterial Adhesins; Bacteriuria; Binding; Blood; Characteristics; Chronic; Clinical Practice Guideline; Clinical Trials; Communicable Diseases; Cost Savings; Cystitis; Data; Detection; Development; Diagnosis; Elderly; Enrollment; Epithelium; Escherichia coli; Failure; Frequencies; Functional disorder; Goals; Grant; Guidelines; Immune; Immune response; Immunocompromised Host; Immunoglobulins; Incidence; Infection; Inflammatory; Injury; Integration Host Factors; Kidney Transplantation; Knowledge; Lead; Mannose; Measures; Mono-S; Multi-Institutional Clinical Trial; Natural History; Outcome; Patients; Pattern; Persons; Population; Predisposition; Prevalence; Prospective Studies; Pyelonephritis; Recommendation; Research; Resistance; Retrospective Studies; Risk; Screening procedure; Societies; Specific qualifier value; Symptoms; Testing; Transplant Recipients; Transplantation; Urinary tract infection; Urine; Uropathogen; Variant; Virulence Factors; Woman; antimicrobial drug; cytokine; design; fimbria; kidney allograft; pregnant; prevent; programs; prospective; public health relevance; type 1 fimbriae; urinary

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(申请人提供)：无症状性细菌尿(ASB)是从没有与尿路感染有关的症状或体征的人身上分离出特定数量的细菌。ASB在女性中很常见，并随着年龄的增长而增加。有一些证据表明，ASB的治疗不能预防症状性尿路感染(UTI)，实际上可能会导致尿路病原菌耐药性的发生率增加，并发症的可能性更高。肾移植受者ASB的发生率以及泌尿系病原菌上表达的某些毒力因子是否会促进症状性尿路感染或急性移植肾损伤仍然存在疑问。在初步的回顾性研究中，我们发现大多数肾移植患者感染了大肠杆菌尿路感染是无症状的。尽管没有尿路感染的症状，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ASB患者肾移植损伤的细菌分离株都表达尿路病理性P菌毛，这是一种粘附素分子，促进细菌与肾上皮细胞的附着，可能参与了损伤性炎症免疫反应。此外，来自肾移植患者的尿液分离出的大肠杆菌ASB经常对用于治疗尿路感染的常见抗菌药产生耐药性。我们建议确定ASB在肾移植患者中的患病率，并确定ASB分离株上表达的宿主特征和细菌毒力因子，以促进症状性尿路感染的发生。从ASB患者中鉴定出表达尿路致病因子的分离株将限制不适当的抗生素使用，并减少UTI对移植肾功能的有害影响。这项研究的最终目标是确定ASB的筛查和治疗是否能预防症状性尿路感染和预防移植肾损伤。来自R21试点拨款的数据将成为肾移植患者ASB多中心临床试验设计的背景。来自这项试验的信息将导致在肾移植人群中对ASB进行急需的筛查和治疗指南。公共卫生相关性：尿路感染(UTIs)是肾移植患者最常见的感染，与肾移植不良和患者存活率有关。目前尚不清楚无症状性尿路感染或无症状性菌尿(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，“不能建议或反对肾移植患者进行ASB筛查或治疗”。需要研究来确定肾移植患者ASB的患病率和宿主特征、细菌毒力因素以及与ABU相关的后果。