Urinary Tract Infections after Kidney Transplantation in Fourteen Medical Centers in Turkey
Hande Arslan1, Melike H Demirkaya1, Oznur Ak2, Mehtap Aydin3, Gule Aydin4, Adalet Aypak5, Yasar Bayindir6, Ziya Demiroglu7, Pinar Ergen8, Gulden Ersoz9, Sibel Gundes10, Esra Kazak11, Behice Kurtaran12, Vildan Oguz13, Yasemin Tezer Tekce14, Mehmet Haberal15.
1Infectious Diseases and Clinical Microbiology, Baskent University, Ankara, Turkey; 2Infectious Diseases and Clinical Microbiology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey; 3Infectious Diseases and Clinical Microbiology, Baskent University, Istanbul, Turkey; 4Infectious Diseases and Clinical Microbiology, Ankara University, Ankara, Turkey; 5Infectious Diseases and Clinical Microbiology, Ankara Numune Education and Research Hospital, Ankara, Turkey; 6Infectious Diseases and Clinical Microbiology, Inonu University, Malatya, Turkey; 7Infectious Diseases and Clinical Microbiology, Baskent University, Adana, Turkey; 8Infectious Diseases and Clinical Microbiology, Medeniyet University Goztepe Education and Research Hospital, Istanbul, Turkey; 9Infectious Diseases and Clinical Microbiology, Mersin University, Mersin, Turkey; 10Infectious Diseases and Clinical Microbiology, Acibadem University, Istanbul, Turkey; 11Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey; 12Infectious Diseases and Clinical Microbiology, Cukurova University, Adana, Turkey; 13Infectious Diseases and Clinical Microbiology, Dokuz Eylul University, Izmir, Turkey; 14Infectious Diseases and Clinical Microbiology, Türkiye Yüksek İhtisas Education and Research Hospital, Ankara, Turkey; 15Transplantation, Baskent University, Ankara, Turkey
SONE Study Group.
Introduction: Urinary tract infection (UTI) is the most common complication after kidney transplantation. It may cause prolonged hospitalization, severe sepsis and graft loss. The aim of this study was to evaluate the number of UTIs that occur after kidney transplantation (KT) and to identify the antimicrobial resistant causative agents.
Materials and Methods: We retrospectively analyzed all the KTs performed between the dates 1st June 2016 and 30th May 2017 and the positive urine cultures of these patients in fourteen different medical centers in seven cities of Turkey.
Results: A total of 488 adult patients underwent transplantation during twelve months period, male gender was predominant with the ratio of 62%. UTI developed in 152 patients (31%), most of the UTIs (40%) were in the period between the second week and the first month after transplantation. In this study 153 UTI attacks were symptomatic and most of patients (%70) had upper urinary tract symptoms. The most common causative agent was Escherichia coli (86) followed by Klebsiella spp. (61). Ratios of extended spectrum beta-lactamase (ESBL) producing Klebsiella spp. and E.coli were respectively 65% and 64%. The ratio of carbapenem resistant Klebsiella spp. strains was 21%, vancomycin resistant enterococcus 3%. Trimethoprim- sulfamethoxazole resistance of all gram negative agents was 60%. We determined nineteen patients with candiduria in this period.
Conclusion: Increasing antibacterial resistance is a major concern for the management of urinary tract infections after kidney transplantation in our country. Accordingly, in this study the high ratios of ESBL producing E.coli and Klebsiella spp. strains and also carbapenem resistance of Klebsiella spp. strains cause difficulties in the empirical treatment in Turkey.
