Infectious complications after kidney transplantation: current epidemiology and associated risk factors

被引:304
作者
Alangaden, George J.
Thyagarajan, Rama
Gruber, Scott A.
Morawski, Katherina
Garnick, James
El-Amm, Jose M.
West, Miguel S.
Sillix, Dale H.
Chandrasekar, Pranatharthi H.
Haririan, Abdolreza
机构
[1] Wayne State Univ, Sch Med, Dept Internal Med, Div Infect Dis, Detroit, MI 48201 USA
[2] Wayne State Univ, Sch Med, Dept Surg, Sect Transplant Surg, Detroit, MI 48201 USA
[3] Wayne State Univ, Sch Med, Dept Internal Med, Div Nephrol, Detroit, MI 48201 USA
关键词
African-American; immunosuppression; infection; kidney transplantation;
D O I
10.1111/j.1399-0012.2006.00519.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: The impact of newer immunosuppressive and antimicrobial prophylactic agents on the pattern of infectious complications following kidney transplantation has not been well studied. Methods: This is an observational study in 127 adult recipients transplanted from 2001 to 2004. Patients received thymoglobulin (ATG) (50%) or basiliximab (50%) for induction and were maintained on mycophenolate mofetil, either tacrolimus (73%) or sirolimus (SRL) (27%), and prednisone (79%). Antimicrobial prophylaxis included perioperative cefazolin, trimethoprim/sulfamethaxazole for six months, valganciclovir for three months and nystatin for two months. Regression models were used to examine the association of various factors with infections. Results: We observed 127 infections in 65 patients, consisting of urinary tract infection (UTI) (47%), viral infections (17%), pneumonia (8%) and surgical wound infections (7%). UTI was the most common infection in all post-transplant periods. Enterococcus spp. (33%) and Escherichia coli (21%) were the most prevalent uropathogens. Of six patients with cytomegalovirus infection, none had tissue-invasive disease. There were no cases of pneumocystis pneumonia or BK nephropathy. Six patients developed fungal infections. Two deaths due to disseminated Rhizopus and Candida albicans accounted for a 1.5% infection-related mortality. Retransplantation and ureteral stents were independently associated with UTI (OR = 4.5 and 2.9, p = 0.06 and 0.03, respectively), as were ATG and SRL with bacterial infections (OR = 3.3 and 2.5, p = 0.009 and 0.047, respectively). Conclusion: This study suggests that the use of newer immunosuppressive agents in recent years is associated with some changes in the epidemiology of post-transplant infections. Enterococci have become the predominant uropathogen. Invasive fungal infections, although rare, are often fatal.
引用
收藏
页码:401 / 409
页数:9
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