Complicaciones infecciosas en 159 receptores de trasplante renal consecutivos

doi:10.1016/j.eimc.2008.02.004

Enfermedades Infecciosas y Microbiología Clínica

Volume 27, Issue 1, January 2009, Pages 22-27

https://doi.org/10.1016/j.eimc.2008.02.004 Get rights and content

Resumen

Introducción

gracias a los avances en la técnica quirúrgica y en el manejo clínico de los receptores de trasplante renal (TR), las infecciones han disminuido su incidencia. Sin embargo, continúan siendo frecuentes y cambiantes en función, en parte, de la profilaxis y la etiología local.

Método

estudio prospectivo y observacional de las infecciones en pacientes con TR realizado entre julio de 2003 y diciembre de 2005, durante los 2 primeros años postrasplante. Se ha realizado un análisis univariado y multivariado de los factores de riesgo asociados al desarrollo de infecciones.

Resultados

la incidencia de infección fue de 1,1 episodios/paciente durante 510±234 días. Los síndromes más frecuentes fueron: infección del tracto urinario (46,6%), infección por citomegalovirus (CMV) (22,7%) e infección de la herida quirúrgica (8%). La etiología fue: bacteriana (50,4%), viral (45,9%) y fúngica (3,6%). Los microorganismos más frecuentes fueron: CMV (36%), Escherichia coli (28%) —el 26% era productora de betalactamasas de espectro extendido (BLEE)—, y Staphylococcus coagulasa negativo (6,3%). El 79% de los episodios sucedieron en los 4 primeros meses postrasplante. Un paciente falleció a los 30 días del episodio de infección. La supervivencia del paciente y del injerto con infección al final del seguimiento fue del 98 y 89%, respectivamente.

Conclusiones

los síndromes más frecuentes son la infección del tracto urinario, la infección por CMV y la infección de la herida quirúrgica. Las infecciones bacterianas son mayoritarias, predominando los bacilos gramnegativos con una elevada tasa de E. coli productor de BLEE.

Abstract

Introduction

The incidence of infections has decreased in kidney transplant (KT) recipients owing to advances in the surgical techniques and clinical management of this population. Nevertheless, these complications continue to occur and the causes seem to be changing, in part because of the prophylactic strategies used.

Method

Prospective, observational study investigating infections occurring during the first 2 years post-transplantation in KT recipients who underwent surgery between July 2003 and December 2005 at Hospital Universitario Virgen del Rocío. Univariate and multivariate regression analysis was performed to determine risk factors associated with the development of infection.

Results

The incidence of infection was 1.11 episodes per patient over 510±234 days. The most common infections were urinary tract infection (UTI) (46.6%), cytomegalovirus (CMV) infection (22.7%), and surgical site infection (8%). The causes were bacterial (50.4%), viral (45.9%), and fungal (3.6%) agents. The most frequent pathogens were CMV (36%), Escherichia coli (28%), extended-spectrum β-lactamase (ESBL)-producers (26%), and coagulase-negative staphylococci (6.3%). Seventy-nine percent of infection episodes occurred in the 4 months following KT. One recipient died 30 days after the infection episode. In the infection group, patient and graft survival at the end of follow-up was 98% and 89%, respectively.

Conclusions

The most frequent syndromes were UTI, CMV infection and surgical site infection. The infections were mainly produced by bacteria, in particular gram-negative rods, and there was a high rate of ESBL E. coli.

Section snippets

Introducción

Antes de 1980, el 60% de los receptores de trasplante renal (TR) tenía al menos un episodio infeccioso grave durante el primer año postrasplante (post-TR) con una mortalidad aproximada del 50%¹. Dicha tasa ha disminuido significativamente en los últimos años, y actualmente es<5%2, 3 gracias a los importantes avances en las técnicas quirúrgicas y de preservación de los órganos, en la inmunosupresión y en las pautas de profilaxis antimicrobiana utilizadas en estos pacientes4, 5, 6. Sin embargo,

Método

Se incluyeron todos los pacientes adultos que recibieron un TR entre julio de 2003 y diciembre de 2005 en el Hospital Universitario Virgen del Rocío de Sevilla. Todos los pacientes se siguieron durante los 2 primeros años postrasplante, hasta la muerte o el final del estudio (30 de junio de 2006).

Resultados

En el período de estudio se incluyeron 159 pacientes, de los cuales 87 (54,7%) fueron varones, con una edad media de 46±12 años. El tiempo de seguimiento medio fue de 510±234 días.

Ciento treinta y tres receptores (83,6%) recibieron tratamiento inmunosupresor con triple terapia (esteroides, antagonistas de la calcineurina y mofetil micofenolato) y 26 (16,4%) con doble terapia (esteroides y antagonistas de la calcineurina). Ochenta y seis pacientes (54%) recibieron tratamiento de inducción con

Discusión

El TR es una sólida opción terapéutica en pacientes con nefropatía crónica terminal⁶. Coincidiendo con otros estudios previos, las principales causas que motivaron el trasplante en nuestra serie fueron la glomerulonefritis, la nefropatía tubulointersticial, la nefropatía hipertensiva y la poliquistosis5, 19, 20.

Analizando la secuencia de aparición de las infecciones tras el trasplante, se distinguen 3 períodos bien definidos6, 9, 20. Durante el primer mes postrasplante, al igual que en estudios

Financiación

Financiado por el Ministerio de Sanidad y Consumo, Instituto de Salud Carlos III, Red de Estudio de Infección en el Trasplante (RESITRA G03/075) y Red Española de Investigación en Patología Infecciosa (REIPI RD06/0008).

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What Is the Part of Tropical Diseases Among Infectious Complications in Renal Transplant Recipients in the Amazon? A 12-Year Multicenter Retrospective Analysis in French Guiana
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Citation Excerpt :
The frequency of UTI after kidney transplantation varies from 31% to 85% depending on the study [8,26,27], revealing likely differences in case definitions and different follow-up periods, but is consistently the most frequent infectious site. The microbiological spectrum was similar to usual descriptions, with a large predominance of Enterobacteriaceae, with E. coli as the main uropathogen [25,28-33]. Twenty percent of UTIs were associated with bacteremia and were the cause of secondary sepsis in 71% of patients (ie, with an identified entry point).
Infectious complications in kidney transplant recipients (KTRs) are well studied in temperate countries but remain barely known in tropical ones. The main objective of this study was to describe infection-related hospitalizations in patients living in the Amazon, where it has never been described.
All KTRs residing in French Guiana between 2007 and 2018 were included retrospectively. Infection-related hospitalizations were collected in the main medical centers of the territory.
Eighty-two patients were included, and 42 were infected during the study period (51%). Eighty-seven infections were identified. The main sites of infection were urinary, in 29% of cases (25/87), and pulmonary, in 22% of cases (19/87). When documented (48/87), bacterial infections were predominant (35/48), followed by viral (8/48), fungal (4/48), and parasitic infections (1/48). Endemic so-called tropical infections accounted for 6% of infections (5/87). Histoplasma capsulatum was the most commonly isolated fungus (2/4).
This study suggests that the spectrum of infections in KTRs in French Guiana differs little from that of temperate countries. Nevertheless, some tropical infections are described. More studies on fungal infections in KTRs should be undertaken to clarify the weight of histoplasmosis in these patients.
De Novo Urologic Malignancies in Renal Transplant Recipients
2018, Transplantation Proceedings
Immunosuppressed organ transplant patients have an elevated risk of malignancies. The aim of this study was to determine the incidence of urologic malignancies in renal transplant recipients, as well as to evaluate their monitoring, treatment, and outcomes.
We conducted a retrospective single-center study of 2897 renal transplants between January 1987 and December 2016. Recipients presenting with de novo urologic malignancies were evaluated. We retrospectively assessed the stage of the disease, treatment performed, and subsequent oncologic outcome. Patients with a history of preexisting cancers were excluded.
Sixty-one de novo urologic malignancies were recorded in 58 patients. The overall incidence of urologic malignancies was 2.2%. We identified 29 cases of prostate cancer, 23 of renal cell carcinoma, 6 of transitional cell carcinoma of the bladder, and 1 case of penile carcinoma. No cases of testicular tumors were found. The mean age at tumor diagnosis was 58.7 ± 10.1 years. The median time between renal transplantation and tumor development was 84 months (range, 2–310 months). Fifty-six (96.6%) patients received deceased donor kidneys. The overall survival rate at 5 years after diagnosis of urologic tumor was 82.8%. Tumor-related death was reported in 13.8% of patients. Nineteen (32.8%) patients had graft loss. Of these, 8 patients had no functional graft when the diagnosis of urologic tumor was made. The therapeutic options did not differ from those used in nontransplanted patients.
Due to the increased incidence of tumors and possibly worse prognosis, renal transplant recipients should be screened more regularly.
Bacteria Isolated from Respiratory Tract Specimens of Renal Recipients with Acute Respiratory Distress Syndrome Due to Pneumonia: Epidemiology and Susceptibility of the Strains
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We estimated species distribution and frequency of antimicrobial resistance among bacterial pathogens isolated from respiratory tract specimens of renal recipients with acute respiratory distress syndrome (ARDS) due to pneumonia.
We retrospectively collected patient demographics and clinical characteristics and microbiologic culture data with the use of standard microbiologic procedures and commercially available tests.
From January 2001 to August 2014, 320 respiratory tract specimens were obtained from 94 renal recipients with ARDS. Bacterial cultures were positive in 134 specimens from 68 recipients (72.3%), yielding 139 bacterial strains. The most commonly isolated species were gram-negative bacteria (111 isolates) with dominance of Acinetobacter baumanii (29.7%) and Pseudomonas aeruginosa (18.0%). The gram-negative bacteria were relatively resistant to 1st- and 2nd-generation cephalosporin and monocyclic beta-lactam and relatively sensitive to levofloxacin and meropenem, with rates of resistance of 80.2%, 76.6%, 73.9%, 36.0%, and 44.1%, respectively. The gram-positive bacteria, excluding Streptococcus uberis, were sensitive to glycopeptides and oxazolidone.
Gram-negative bacteria predominated as 79.9% of isolates from respiratory tract specimens of renal recipients with ARDS. The gram-negative bacteria were relatively sensitive to levofloxacin and meropenem and the gram-positive bacteria were sensitive to glycopeptides and oxazolidone.
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Pneumonia remains an important cause of morbidity among solid organ transplant recipients.
We prospectively evaluated all renal transplant patients at our center from July 2003 to December 2008 who had pneumonia that required hospitalization. We gathered data regarding underlying diseases as well as pretransplant, transplant, and posttransplant characteristics. Pneumonia defined according to the Centers for Disease Control and Prevention criteria was classified depending on its origin as community acquired or nosocomial. In all patients, microbiologic samples of respiratory secretions and blood were collected at the physician's discretion. The indication to perform a fiberoptic bronchoscopy was the presence of multiple, bilateral, or diffuse pulmonary infiltrates or the absence of a clinical or radiologic response after 3 days of antimicrobial therapy.
Among 610 kidney transplant recipients, we diagnosed 60 episodes of pneumonia in 54 patients (8.8%), of which 23 had a nosocomial origin (38%) and 37 community acquired (62%). Bacterial infection was the most frequent etiology (44%), followed by fungal in 4 (7%) and viral in 2 (3.5%). The most commonly isolated microorganism in nosocomial pneumonia was Pseudomonas aeruginosa (26%, among which 50% was multidrug resistant). In 34% there was no microbiologic isolation. The most common pathogen among community-acquired pneumonias was Strepococcus pneumoniae (11%). In 54% of cases there was no microbiologic confirmation of disease. The overall accuracy of bronchoalveolar lavage was 72%. A total of 21 patients with pneumonia (35%) were admitted to the intensive care unit; of these, 14 had a nosocomial origin (60%) and 9 (15%) died due to the infection (8 [88%] of whom had nosocomial pneumonia; P = .001).
Our data confirmed that nosocomial pulmonary infections are associated with considerable morbidity and mortality in renal transplant recipients. The performance of invasive procedures is useful for the diagnosis of pneumonia.
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OriginalComplicaciones infecciosas en 159 receptores de trasplante renal consecutivosInfectious diseases in 159 consecutive kidney transplant recipients

Resumen

Introducción

Método

Resultados

Conclusiones

Abstract

Introduction

Method

Results

Conclusions

Section snippets

Introducción

Método

Resultados

Discusión

Financiación

Infect Dis Clin North Am

Transplant Proc

Transplant Proc

Transplant Proc

Surg Clin North Am

Enferm Infecc Microbiol Clin

Am J Transplant

Transplant Proc

Transplant Proc

Kidney Int

Am J Transplant

Int Immunopharmacol

Prospective study of renal transplant infections in 50 consecutives patients

Eur J Clin Microbiol Infect Dis

Infections in renal transplant recipients receiving micophenolate versus azathioprine-based inmunosuppression

Eur J Clin Microbiol Infect Dis

Nosocomial infection in kidney transplant recipients: a retrospective analyses of a single-center experience

Transplant Proc

Original
Complicaciones infecciosas en 159 receptores de trasplante renal consecutivosInfectious diseases in 159 consecutive kidney transplant recipients