[肾移植术后1个月尿路感染]。

E Renoult, F Aouragh, D Mayeux, D Hestin, J Hubert, J L'Hermite, C Amicabile, M Weber, M Zerrouki-Bellou, M F Blech
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摘要

本文对255例(252例)肾移植术后1个月内尿路感染(UTI)的发生率及易感因素进行了研究。73.7%的移植物出现尿路感染。最常见的病原菌为大肠杆菌(35.8%)、葡萄球菌(33.6%)、D型链球菌(11.2%)、克雷伯菌(5.3%)。39%的病例感染复发。大多数尿路感染无症状,但7%的感染导致败血症。终末期肾病的病因、移植前双肾切除术、无症状膀胱输尿管反流进入患者自身肾脏、免疫抑制治疗的类型、急性肾小管坏死、排斥反应发作、泌尿系统并发症、共存的其他感染均不是诱发因素。细菌尿在女性患者中比在男性患者中更常见。术前有尿路感染史(p = 0.039)和输尿管导管使用(p = 0.018)的患者尿路感染发生率均有统计学意义。供体在脑死亡前接受抗生素治疗时,尿路感染的发生率较低(p = 0.025)。这些结果为移植后第一个月定期监测尿液培养提供了额外的支持。它们应有助于确定减少这种传染风险的手段。
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[Urinary tract infections during the 1st month after kidney transplantation].

The incidence and the predisposal factors of urinary tract infections (UTI) in the first month post-transplant were studied in 255 kidney transplantations (252 patients). UTI episodes were demonstrated in 73.7% of the grafts. The most common organisms were: Escherichia coli (35.8%), Staphylococcus (33.6%), Streptococcus D (11.2%), Klebsiella (5.3%). The infectious episodes were recurrent in 39% of the cases. The majority of the UTIs were asymptomatic but 7% of the infections led to septicaemia. Etiology of end-stage renal disease, pre-graft binephrectomy, asymptomatic vesicoureteral reflux into the patient's own kidneys, type of immunosuppressive treatment, acute tubular necrosis, rejection episodes, urological complications, coexistent other infections were not predisposal factors. Bacteriuria was more frequent in female than in male patients. The incidence of UTI was found to be statistically increased with history of UTI preoperatively (p = 0.039) and the use of ureteral catheter (p = 0.018). Occurrence of UTI was less common when the donor was treated by antibiotics before brain death (p-0.025). These results provide additional support for regular monitoring of urine cultures in the first month post-transplant. They should help to identify means of reduction of this infectious risk.

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