Significance of positive urine cultures during the immediate post-trasnplant period in renal transplant recipients. A retrospective study
Abstract number: P813
Koukoulaki M., Baraboutis I., Platsouka E., Papastamopoulos V., Hadjiconstantinou V., Paniara O., Skoutelis A., Drakopoulos S.
Purpose: Urinary tract infections (UTI) are the commonest bacterial infections in renal transplant recipients. The study of UTIs in the immediate post-transplant period is of particular importance (higher degree of immunosuppression, presence of foreign bodies, exposure to nosocomial pathogens). Purpose of this retrospective study was to audit UTIs during the first post-transplant month and identify potential risk factors.
Patients and Methods: Renal transplant recipients with complete urine culture (UC) and urinalysis data for the first post-transplant month (period of September 2002-September 2007) were included in the study. All recipients, besides the induction therapy and triple immunosuppressive regimen, were treated with prophylactic antibiotics, namely intravenous cephotaxime for 10 days and then per os ciprofloxacin for six weeks.
Results: 116 renal transplant recipients (mean age 50.6±9.7 years, male gender in 74.1%) were studied. During the follow-up period of one month, 50 positive UCs were identified, derived from 38 (32.7%) recipients. A total of 27 recipients had only one positive UC. Urinalysis identified pyuria in 18 out of 38 recipients. Most frequent pathogens were Gram(+) bacteria (22/50.44%) (Enterococcus faecalis commonest), followed by Gram(-) bacteria (17/50.36%) (Pseudomonas aeruginosa commonest) and fungi (11/50, 22%) (3 Candida albicans, 8 Candida non-albicans). Mean time of identification of positive UC was 14±4.7 days post transplantation. Preliminary statistical analysis revealed significant association of probability of a positive UC with female gender (Pearson c2, p = 0.043) and cold ischaemia time (non-parametric test Mann Whitney U, p = 0.005). When the analysis included only the positive UCs accompanied with significant pyuria (defined as 810 white cells/hpf), the above-mentioned associations were not reproduced.
Conclusions: Positive UCs were observed in 32.7% of renal transplant recipients, with Enterococcus faecalis and Pseudomonas aeruginosa being the commonest pathogens. It should be emphasised that all patients with positive UCs received specific antimicrobial therapy, irrespective of symptoms or puyria, due to concerns for defective inflammatory response. The issue of when to treat an isolated positive UC by a potential pathogen in the immediate post-transplant period has not been resolved. The probability of a positive UC in the first post-transplant month was related to female gender and cold ischaemia time.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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