Bacterial urinary tract infections in patients after kidney transplantation

Trushkin R.N., Lubennikov A.E., Makurov A.I.

This article contains the review of the modern literature related to the questions of the diagnostics and treatment of bacterial urinary tract infections (UTI) in patients after kidney transplantation, which are the most often reason for the hospital admission. Until recently the main infectious agents were considered to be enterobacteria, nowadays the trend is evident to the increase of the number of infections caused by enterococci and non-fermenting gram-negative bacteria, which should be accounted for during the selection of antimicrobial chemotherapy. It is also important to regard the growing number of resistant strains, which produce the betalactamases of the wide spectrum. It could be possibly linked to the antibacterial prophylaxis prescribed for the period of 6 months after the renal transplantation. Nevertheless, the metaanalyses show, that this prophylaxis must be implemented due to certain decrease of the bacteriuria and septic complications. Urological complications of the transplantation (obstruction, fistulae, urine extravasation, enteral necrosis, nephrolithiasis etc.), lower urinary tract dysfunctions and diseases of the own kidneys could lead to the development and sustenance of UTI almost in 100% of the cases. Therefore they must be eliminated first of all. The other important factors are female gender, advanced age, long-lasting drainage of the bladder with catheter, long stay in the clinic and also the immunosuppression is of paramount importance. The influence of the UTI on the transplant function, its survival and survival of patients is widely discussed in literature without, however, an uniform opinion. Probably, UTIs are not leading to the transplant dysfunction, however associated with the increased patient lethality. The questions of the treatment of patients with UTI are also discussed in the review.

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