Institutional protocol adherence in the incidence of recurrent urinary tract infection after kidney transplantation
| Autor: | Lorena Martinho, Fernanda Spadão, Lígia Camera Pierrotti, Elias David-Neto, William C. Nahas, Maristela Pinheiro Freire, Clara V. Mendes, Flávio Jota de Paula |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
0301 basic medicine
Microbiology (medical) medicine.medical_specialty Urinary system 030106 microbiology Immunology Disease Diabetic nephropathy Multidrug resistance Microbiology Kidney transplantation 03 medical and health sciences 0302 clinical medicine Recurrence Internal medicine medicine Immunology and Allergy Humans Stewardship 030212 general & internal medicine Retrospective Studies Urinary tract infection business.industry Proportional hazards model Incidence (epidemiology) Incidence Retrospective cohort study medicine.disease QR1-502 Treatment Propensity score matching Urinary Tract Infections business |
| Zdroj: | Journal of Global Antimicrobial Resistance, Vol 23, Iss, Pp 352-358 (2020) |
| ISSN: | 2213-7165 |
| Popis: | Objectives Recurrent urinary tract infections (rUTIs) occur frequently after kidney transplantation (KT), however their optimal management remains undefined. This study aimed to identify risk factors for rUTI and to validate a protocol for UTI and rUTI treatment after KT. Methods This retrospective cohort study involved patients undergoing KT between January 2013 and July 2016. Patients were followed-up from day of KT until graft loss, death or end of follow-up (31 December 2018). We analysed all episodes of symptomatic UTI. The main outcome measure was rUTI after KT. Analysis was done per episode in a multilevel approach; patient features were considered in the distal level and UTI features in the proximal level. Univariate and multivariate analyses were performed by Cox regression. A propensity score was used to adjust the risk of patients with carbapenem-resistant Enterobacteriaceae. Results During the study period, 787 patients underwent KT, of whom 152 (19.3%) developed 356 UTI episodes. The most common micro-organisms wereEscherichia coli (165/356; 46.3%) and Klebsiella pneumoniae (101/356; 28.4%). Multidrug-resistant micro-organisms were isolated in 161 UTIs (45.2%). Risk factors for rUTI were diabetic nephropathy as the cause of end-stage renal disease (P = 0.02), UTI in first 180 days after KT (P = 0.04), anatomic alteration of the urinary tract at UTI diagnosis (P = 0.004) and length of time to effective therapy (P = 0.002); UTI treatment duration according to institutional protocol (P = 0.04) was the only protective factor identified. Conclusion Appropriate therapy duration has an impact on rUTI prevention after KT. |
| Databáze: | OpenAIRE |
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