Böbrek nakli alıcılarında üriner traktüs enfeksiyonlarının retrospektif analizi
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Date
2020
Authors
Özçelik, Ender Eren
Journal Title
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Publisher
Bursa Uludağ Üniversitesi
Abstract
Böbrek nakli sonrası üriner traktüs enfeksiyonu geçiren hastaların özellikleri ve risk faktörlerini değerlendirdiğimiz, atakların greft ve hasta sağkalımı üzerine olan etkilerini araştırdığımız çalışmamızda, Bursa Uludağ Üniversitesi Tıp Fakültesi Hastanesi Böbrek Nakil Merkezi’nde Ocak 2006 – Mayıs 2019 tarihleri arasında böbrek transplantasyonu yapılan 550 hastayı retrospektif olarak inceledik. Serimizdeki üriner traktüs enfeksiyonu insidansı %36.4’tü. Kadın cinsiyet, ileri nakil yaşı ve ileri donör yaşı, nakil öncesi medyan diyaliz süresinin uzun olması, nakil sonrası uzamış foley kateter ve yatış süresi, sitomegalovirüs enfeksiyonu, vezikoüreteral reflü ve nörojenik mesane öyküsünün üriner traktüs enfeksiyonu için risk faktörü olduğu tespit edildi. Hasta sağkalım analizlerinde canlı vericiden yapılan nakil, kadın cinsiyet, idame immunsüpresif tedavi olarak takrolimus + mikofenolat mofetil + kortikosteroid kombinasyonu kullanımı, periton diyalizi alan hastalara göre preemptif nakiller daha uzun yaşam süresi; ileri nakil yaşı, obezite, gecikmiş greft fonksiyonu, akut rejeksiyon, diabetes mellitus ve sitomegalovirüs enfeksiyon öyküsü de daha kısa yaşam süresi ile ilişkili görüldü. Üriner traktüs enfeksiyonu grubunun %37’sinde rekürren enfeksiyon saptandı. Her iki grupta da en sık izole edilen etken Escherichia coli idi. Üriner traktüs enfeksiyonları, nakil sonrası sık görülen önemli bir komplikasyondur. Bu nedenle risk faktörleri dikkatle değerlendirilerek, etkin bir şekilde tedavi edilmelidir. Çok merkezli çalışmalar, bu komplikasyonun yönetimi ve tedavi algoritmalarının belirlenmesinde faydalı olacaktır.
In our study, in which we evaluated the characteristics and risk factors of patients with urinary tract infection after kidney transplantation and investigated the effects of episodes on graft and patient survival, we retrospectively examined 550 patients who underwent kidney transplantation between January 2006 and May 2019 at Bursa Uludag University Medical Faculty Hospital Kidney Transplantation Center. The incidence of urinary tract infection in our series was 36.4%. Female gender, advanced age of transplantation and advanced donor age, long median dialysis time before transplantation, prolonged foley catheter and hospitalization time after transplantation, cytomegalovirus infection, histories of vesicoureteral reflux and neurogenic bladder were found to be risk factors for urinary tract infection. In patient survival analysis, living donor transplantation, female gender, use of tacrolimus-mycophenolate mofetil-corticosteroid combination as maintenance immunosuppressive therapy, preemptive transplants compared to patients who received peritoneal dialysis had longer life span; advanced age of transplantation, obesity, delayed graft function, acute rejection, diabetes mellitus and a history of cytomegalovirus infection were also associated with a shorter life span. Recurrent infection was detected in 37% of the urinary tract infection group. Escherichia coli was the most frequently isolated agent in both groups. Urinary tract infections are a common serious complication after transplantation. Therefore, risk factors should be carefully evaluated and treated effectively. Multi-center studies will be useful in managing this complication and determining treatment algorithms.
In our study, in which we evaluated the characteristics and risk factors of patients with urinary tract infection after kidney transplantation and investigated the effects of episodes on graft and patient survival, we retrospectively examined 550 patients who underwent kidney transplantation between January 2006 and May 2019 at Bursa Uludag University Medical Faculty Hospital Kidney Transplantation Center. The incidence of urinary tract infection in our series was 36.4%. Female gender, advanced age of transplantation and advanced donor age, long median dialysis time before transplantation, prolonged foley catheter and hospitalization time after transplantation, cytomegalovirus infection, histories of vesicoureteral reflux and neurogenic bladder were found to be risk factors for urinary tract infection. In patient survival analysis, living donor transplantation, female gender, use of tacrolimus-mycophenolate mofetil-corticosteroid combination as maintenance immunosuppressive therapy, preemptive transplants compared to patients who received peritoneal dialysis had longer life span; advanced age of transplantation, obesity, delayed graft function, acute rejection, diabetes mellitus and a history of cytomegalovirus infection were also associated with a shorter life span. Recurrent infection was detected in 37% of the urinary tract infection group. Escherichia coli was the most frequently isolated agent in both groups. Urinary tract infections are a common serious complication after transplantation. Therefore, risk factors should be carefully evaluated and treated effectively. Multi-center studies will be useful in managing this complication and determining treatment algorithms.
Description
Keywords
Böbrek nakli, Komplikasyon, Risk, Sağkalım, Sonuç, Enfeksiyon, Üriner traktüs enfeksiyonu, Kidney transplant, Complication, Infection, Risk, Survival, Outcomes, Urinary tract infection
Citation
Özçelik, E. E. (2020). Böbrek nakli alıcılarında üriner traktüs enfeksiyonlarının retrospektif analizi. Yayınlanmamış tıpta uzmanlık tezi. Bursa Uludağ Üniversitesi Tıp Fakültesi.