Symptomatic and asymptomatic bacteriuria in a pediatric cohort of kidney transplants from a hospital in Paraguay
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Pediatric Nephrology Unit. Hospital Central del Instituto de Previsión Social, Paraguay
Universidad Católica Nuestra Señora de la Asunción, Campus Asunción, Paraguay
Hillmont GI, United States
Ribeirão Preto Medical School, University of São Paulo, Brazil
Online publication date: 2019-09-11
Publication date: 2019-09-11
Electron J Gen Med 2019;16(5):em152
Bacteriuria is common in kidney transplant recipients (KTR) and it may affect graft survival.

To describe the incidence, clinical manifestations and microbial susceptibility of the symptomatic (SB) and asymptomatic (AB) bacteriuria in KTR, and to define the initial empirical treatment.

Retrospective cohort study of all KTR<18 years with bacteriuria that were transplanted between January 2006 and December 2016. Clinical, demographic, laboratory characteristics and follow-up time were investigated. Bacteriuria was classified as either SB or AB. Statistical analysis was performed using Excel 2010 program.

20 kidney transplants were performed. The female/male ratio was approximately 2:1 and 45% of the patients had bacteriuria. Of the 55 bacteriuria episodes, 20 were symptomatic and 35 asymptomatic. The mean age of the patients was 10.7±4.7 years. The more frequent primary renal diseases were neurogenic bladder (44.4%), renal dysplasia (22.2%), nephronophthisis, vesicoureteral reflux and obstructive uropathy (11.1% each). The median number of episodes/patient was 3.9. The mean time to post-transplant presentation was &lt;6 months in 25% of the cases, 6-12 months in 20% and &gt;12 months in 54.5%. The median time between the transplantation and the first AB episode was 3 months, and between the first SB episode was 7 months. The symptoms found in patients with SB included fever (80%), hematuria (15%) and septic shock (5%). No patient died due to urinary tract infections (UTI), but 33.3% of the patients with bacteriuria required admission to intensive care units. The most frequent bacteria isolated was Escherichia coli (E.coli) (54.5%). Extended‐spectrum beta‐lactamase (ESBL) producing bacteria was found in 20% of the isolates. When comparing SB and AB, E.coli was associated with SB (p=0.047 OR:1-9.9). All SB cases were verified in patients with neurogenic bladder (p=0.013).

The recognition of high incidence of ESBL producing bacteria- related to UTI in (children) KTR may be very important for decision on the use of antibiotics during post- transplantation period. In this case, the use of carbapenem and ciprofloxacin should be recommended as initial empiric treatment.

Karuthu S, Blumberg EA. Common infections in kidney transplant recipients. Clin J Am Soc Nephrol. 2012;7(12):2058-70. https://doi.org/10.2215/CJN.04... PMid:22977217.
Mudalige NL, Kessaris N, Stojanovic J, Marks SD. Improved outcomes for paediatric renal transplant recipients. Paediatr Child Health (Oxford). 2018;28(7): 337-43. https://doi.org/10.1016/j.paed....
Ko KS, Cho DO, Ahn JH, et al. Infections after renal transplantation. Transplant Proc. 1994; 26(4):2072-4.
Chacón-Mora N, Díaz JP, Matía EC. Urinary tract infection in kidney transplant recipients. Enferm Infecc Microbiol Clin. 2017;35(4):205–70. https://doi.org/10.1016/j.eimc... PMid:27112976.
Sharifian M, Rees L, Trompeter RS. High incidence of bacteriuria following renal transplantation in children. Nephrol Dial Transplant. 1998;13(2):432–5. https://doi.org/10.1093/oxford... PMid:9509458.
Cairns HS, Spencer S, Hilson AJ, Rudge CJ, Neild GH. 99mTc-DMSA imaging with tomography in renal transplant recipients with abnormal lower urinary tracts. Nephrol Dial Transplant. 1994;9(8):1157–61. https://doi.org/10.1093/ndt/9.... PMid:7800217.
Souza RM, Olsburgh J. Urinary tract infection in the renal transplant patient. Nat Clin Pract Nephrol. 2008;4(5):252-64. https://doi.org/10.1038/ncpnep... PMid:18334970.
Vidal E, Torre-Cisneros J, Blanes M, et al. Bacterial urinary tract infection after solid organ transplantation in the RESITRA cohort. Transpl Infect Dis. 2012;14(6):595-603. https://doi.org/10.1111/j.1399... PMid:22650416.
El Amari EB, Hadaya K, Bühler L, et al. Outcome of treated and untreated asymptomatic bacteriuria in renal transplant recipients. Nephrol Dial Transplant. 2011;26(12):4109-14. https://doi.org/10.1093/ndt/gf... PMid:21592976.
Aguado JM, Silva JT, Fernández-Ruiz M, et al. Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant Rev (Orlando). 2018;32(1):36–57. https://doi.org/10.1016/j.trre... PMid:28811074.
Wu X, Dong Y, Liu Y, et al. The prevalence and predictive factors of urinary tract infection in patients undergoing renal transplantation: a meta-analysis. Am J Infect Control. 2016;44(11):1261-8. https://doi.org/10.1016/j.ajic... PMid:27311513.
Khosravi AD, Abasi Montazeri E, Ghorbani A, Parhizgari N. Bacterial urinary tract infection in renal transplant recipients and their antibiotic resistance pattern: a four-year study. Iran J Microbiol. 2014;6(2):74-8.
Giraldo-Ramírez S, Díaz-Portilla OE, Miranda-Arboleda AF, Henao-Sierra J, Echeverri-Toro LM, Jaimes F. Urinary tract infection leading to hospital admission during the first year after kidney transplantation: a retrospective cohort study. Transplantation Reports. 2016;1(3-4):18–22. https://doi.org/10.1016/j.tpr.....
John U, Everding AS, Kuwertz-Broking E, et al. High prevalence of febrile urinary tract infections after paediatric renal transplantation. Nephrol Dial Transplant. 2006;21(11):3269-74. https://doi.org/10.1093/ndt/gf... PMid:16963479.
Akia FT, Aydina AM, Dogana HS, et al. Does lower urinary tract status affect renal transplantation outcomes in children? Transplant Proc. 2015;47(4):1114-6. https://doi.org/10.1016/j.tran... PMid:26036532.
Korayem GB, Zangeneh TT, Matthias KR. Recurrence of urinary tract infections and development of urinary-specific antibiogram for kidney transplant recipients. J Glob Antimicrob Resist. 2018;12:119-23. https://doi.org/10.1016/j.jgar... PMid:28859935.
Dhillon RH, Clark J. ESBLs: a clear and present danger?. Crit Care Res Pract. 2012;2012:625170. https://doi.org/10.1155/2012/6... PMid:21766013 PMCid:PMC3135063.
Silva A, Rodig N, Passerotti CP, et al. Risk factors for urinary tract infection after renal transplantation and its impact on graft function in children and young adults. J Urol. 2010;184(4):1462–7. https://doi.org/10.1016/j.juro... PMid:20727542.
Dupont PJ, Psimenou E, Lord R, Buscombe JR, Hilson AJ, Sweny P. Late recurrent urinary tract infections may produce renal allograft scarring even in the absence of symptoms or vesicoureteric reflux. Transplantation. 2007;84(3):351–5. https://doi.org/10.1097/01.tp.... PMid:17700160.