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Abstract
Introduction: The kidney transplant recipient is a high-risk patient for infection due to potential surgical complications and immunosuppressive treatment.
The development of infections poses an increased risk of graft loss and mortality.
Objectives: The main objective was to determine the incidence of the most frequent infections in renal transplant patients during the immediate post-transplant period. The secondary objectives were to describe the most frequent infection-producing germs and to analyse the relationship between the types of infection studied and their possible risk factors.
Methodology: Retrospective observational study in renal transplant patients between January 2018 and December 2019 during the immediate post-transplant period.
Results: The incidence of infection was 69.4%, the syndromes described were urinary tract infection (48%), bacteraemia (9.2%), catheter-related infection (8.2%) and cytomegalovirus infection (4.1%). The main microorganisms involved were Escherichia coli (16.3%), Enterococcus faecium (12.2%) and Enterobacter cloacae (8.1%).
A significant relationship was found between the occurrence of infection and the duration of admission, as well as with the presence or absence of a personal history of arterial hypertension. There was also a significant association between the incidence of central venous catheter-related infection and the length of time the catheter was inserted.
Conclusions: The most frequent infection found in the immediate post-renal transplant period was urinary tract infection, while the most common micro-organism present in the infectious processes was Escherichia coli.
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References
- Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. Jun 2013;3(1):1-150.
- Faraldo Cabana A, Ibáñez Rebé M, Del Río Rodríguez M, Esteban Polonio C, Lope Andrea T, Muñoz Jiménez D. Frecuencia de los diagnósticos de enfermería en el primer ingreso del paciente con un trasplante renal reciente. Enferm Nefrol. 2017;20(1):76-81. DOI: https://doi.org/10.4321/S2254-28842017000100010
- Berlango Jiménez, J. Indicaciones del trasplante renal. Preparación preoperatoria. En: Force, A. La Enfermería y el trasplante de órganos. Madrid. Ed. Panamericana. 2004. p. 89.
- Hernández Marrero D, González-Molina Alcaide M. Resultados Globales del Trasplante Renal. En: Lorenzo V, López Gómez JM. Nefrología al Día [Internet]. [consultado 30 Jun 2020]. Disponible en: http://www.revistanefrologia.com/es-monografias-nefrologia-dia-articulo-resultados-globales-del-trasplante-renal-58.
- Ojo AO, Morales JM, González-Molina M, Steffick DE, Luan FL, Merion RM, et al. Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant. 2013;28(1):213-20. DOI: https://doi.org/10.1093/ndt/gfs287
- Bell R, Farid S, Pandanaboyana S, Upasani V, Baker R, Ahmad N. The evolution of donation after circulatory death renal transplantation: a decade of experience. Nephrol Dial Transplant. 2019;34(10):1788-98. DOI: https://doi.org/10.1093/ndt/gfy160
- Lodhi SA, Lamb KE, Meier-Kriesche HU. Solid organ allograft survival improvement in the United States: the long-term does not mirror the dramatic short-term success. Am J Transplant. 2011 Jun;11(6):1226-35. DOI: https://doi.org/10.1111/j.1600-6143.2011.03539.x
- Chen HS, Wang FD, Lin Y-C, Huang LJ, Liu CY. Risk factors for central venous catheter-related infections in general surgery. J Microbiol Immunol Infection. 2006;39:231-6.
- Hammarskjöld F, Wallén G, Malmvall BE. Central venous catheter infections at a county hospital in Sweden: a prospective analysis of colonization, incidence of infection and risk factors. Acta Anaesthesiol Scand. 2006;50:451-60. DOI: https://doi.org/10.1111/j.1399-6576.2006.00974.x
- Brar S, Wang Y, Cannitelli A, Lambadaris M, Li Y, Famure O, et al. Bacteremia in kidney transplant recipients: Burden, causes, and consequences. Clinical Transplantation. 2019; 33:e13479. DOI: https://doi.org/10.1111/ctr.13479
- Galindo Sacristán P, Pérez Marfil A, Osorio Moratall JM, de Gracia Guindo C, Ruiz Fuentes C, Castilla Barbosa YA, et al. Predictive factors of Infection in the 1st year after kidney transplantation. Transpl Proc. 2013;45:3620-3. DOI: https://doi.org/10.1016/j.transproceed.2013.11.009
- Actividad de donación y trasplante renal. España 2019. Ministerio de Sanidad, Servicios Sociales e Igualdad. [Consultado 04 Jul 2020]. Disponible en: http://www.ont.es/infesp/Memorias/Actividad_de_Donaci%C3%B3n_y_Trasplante_Renal_2019.pdf.
- Al-Hasan MN, Razonable RR, Kremers WK, Baddour LM. Impact of Gram-negative bloodstream infection on long-term allograft survival after kidney transplantation. Transplantation. 2011;91(11):1206-10. DOI: https://doi.org/10.1097/TP.0b013e3182180535
- Parasuraman R, Abouljoud M, Jacobsen G, Reddy G, Koffron A, Venkat KK. Increasing trend in infection-related death-censored graft failure in renal transplantation. Transplantation. 2011;91(1):94-9. DOI: https://doi.org/10.1097/TP.0b013e3181fdd96c
- Skov Dalgaard L, Nørgaard M, Povlsen JV, Morrissey O, Jespersen B, Jensen-Fangel S ,et al. Risk and prognosis of bacteremia and fungemia among first-time kidney transplant recipients: a population-based cohort study. Infect Dis (Lond). 2017 Apr;49(4):286-95. DOI: https://doi.org/10.1080/23744235.2016.1248483
- Rodríguez Martínez R, Bacallao Méndez R, Gutiérrez García F, Fonseca Hernández D. Complicaciones del trasplante renal en el Instituto de Nefrología. 2001-2005. Rev Soc Esp Enferm Nefrol. 2010;13(1):7-15. DOI: https://doi.org/10.4321/S1139-13752010000100002
- Kritikos A, Oriol M. Bloodstream infections after solid-organ transplantation. Virulence. 2016;7(3):329-40. DOI: https://doi.org/10.1080/21505594.2016.1139279
- Silva M, Marra AR, Pereira CA, Medina-Pastana JO, Camargo LF. Bloodstream infection after kidney transplantation: epidemiology, microbiology, associated risk factors, and outcome. Transplantation. 2010;90(5):581-7. DOI: https://doi.org/10.1097/TP.0b013e3181e8a680
- Moreno A, Cervera C, Gavalda J, Rovira M, de la Camara R, Jarque I, et al. Bloodstream infections among trasplant recipients: results of a nationwide surveillance in Spain. Am J Trasplant. 2007;7(11):2579-86. DOI: https://doi.org/10.1111/j.1600-6143.2007.01964.x
- Al-Hasan MN, Razonable RR, Eckel-Passow JE, Baddour LM. Incidence rate and outcome of gram-negative bloodstream infection in solid organ transplant recipients. Am J Trasplant. 2009;9(4):835-43. DOI: https://doi.org/10.1111/j.1600-6143.2009.02559.x
- Tolkoff-Rubin NE, Rubin RH. The infectious disease problems of the diabetic renal transplant recipient. Infect Dis Clin North Am. 1995;9(1):117-30. DOI: https://doi.org/10.1016/S0891-5520(20)30643-7
- Moghadamyeghaneh Z, Chen LJ, Alameddine M, Gupta AK, Burke GW, Ciancio G. Never events and hospital-acquired conditions after kidney transplant. Can Urol Assoc J. 2017 Nov;11(11):E431-E436. DOI: https://doi.org/10.5489/cuaj.4370
- Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40. DOI: https://doi.org/10.1016/0196-6553(88)90053-3
- Pujol M, Limón E. Epidemiología general de las infecciones nosocomiales. Sistemas y programas de vigilancia. Enferm Infecc Microbiol Clin. 2013;31(2):108-13. DOI: https://doi.org/10.1016/j.eimc.2013.01.001
- US Renal Data System. USRDS. 2011 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda, Maryland: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2011.
- Hernández D, Moreso F. Has patient survival following renal transplantation improved in the era of modern immunosuppression? Nefrología. 2013;33:171-80.
- Martorell J. Mecanismos de respuesta inmune e infección. En: Aguado García J, Fortún Abete J, Gavaldá Santapau J, Pahissa Berga A, de la Torre Cisneros J. Infecciones en pacientes trasplantados. 3rd ed. 2009;49-59.
- Figueroa-Sánchez GE, Arreola JM, Morales-Buenrostro LE. Factores de riesgo para infección de vías urinarias en el periodo postrasplante renal temprano. Revista Mexicana de Trasplantes. 2012;1(1):22-8.
- Cong-Tat C, Ming-Ji L, Chia-Wen L, Nan-Yao L, Shen-Shin C, Ching-Chi L, et al. Community-onset bacteremia in kidney transplant recipients: The recipients fare well in terms of mortality and kidney injury. Journal of Microbiology, Immunology and Infection. 2016;49:685-91. DOI: https://doi.org/10.1016/j.jmii.2014.08.027
- García-Prado ME, Cordero E, Cabello V, Pereira P, Torrubia FJ, Ruíz M, et al. Complicaciones infecciosas en 149 receptores de trasplante renal consecutivos. Enferm Infecc Microbiol Clín. 2009;27(1):22-7. DOI: https://doi.org/10.1016/j.eimc.2008.02.004
- López-Oliva MO, Flores J, Madero R, Escuin F, Santana MJ, Bellón T, et al. Cytomegalovirus infection after kidney transplantation and long-term graft loss. Nefrologia. 2017 Sep-Oct; 37(5):515-25. DOI: https://doi.org/10.1016/j.nefroe.2016.11.018
- O' Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections. Centers for Disease Control and Prevention. MMWR 2002;51(No.RR-10):13-6.
- Elliot T, Timsit J-F. EPIC3: Guidelines for preventing infections associated with the use of intravascular access devices. J Hosp Infect. 2014 Jul;87(3):182. DOI: https://doi.org/10.1016/j.jhin.2014.02.014
References
Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int Suppl. Jun 2013;3(1):1-150.
Faraldo Cabana A, Ibáñez Rebé M, Del Río Rodríguez M, Esteban Polonio C, Lope Andrea T, Muñoz Jiménez D. Frecuencia de los diagnósticos de enfermería en el primer ingreso del paciente con un trasplante renal reciente. Enferm Nefrol. 2017;20(1):76-81. DOI: https://doi.org/10.4321/S2254-28842017000100010
Berlango Jiménez, J. Indicaciones del trasplante renal. Preparación preoperatoria. En: Force, A. La Enfermería y el trasplante de órganos. Madrid. Ed. Panamericana. 2004. p. 89.
Hernández Marrero D, González-Molina Alcaide M. Resultados Globales del Trasplante Renal. En: Lorenzo V, López Gómez JM. Nefrología al Día [Internet]. [consultado 30 Jun 2020]. Disponible en: http://www.revistanefrologia.com/es-monografias-nefrologia-dia-articulo-resultados-globales-del-trasplante-renal-58.
Ojo AO, Morales JM, González-Molina M, Steffick DE, Luan FL, Merion RM, et al. Comparison of the long-term outcomes of kidney transplantation: USA versus Spain. Nephrol Dial Transplant. 2013;28(1):213-20. DOI: https://doi.org/10.1093/ndt/gfs287
Bell R, Farid S, Pandanaboyana S, Upasani V, Baker R, Ahmad N. The evolution of donation after circulatory death renal transplantation: a decade of experience. Nephrol Dial Transplant. 2019;34(10):1788-98. DOI: https://doi.org/10.1093/ndt/gfy160
Lodhi SA, Lamb KE, Meier-Kriesche HU. Solid organ allograft survival improvement in the United States: the long-term does not mirror the dramatic short-term success. Am J Transplant. 2011 Jun;11(6):1226-35. DOI: https://doi.org/10.1111/j.1600-6143.2011.03539.x
Chen HS, Wang FD, Lin Y-C, Huang LJ, Liu CY. Risk factors for central venous catheter-related infections in general surgery. J Microbiol Immunol Infection. 2006;39:231-6.
Hammarskjöld F, Wallén G, Malmvall BE. Central venous catheter infections at a county hospital in Sweden: a prospective analysis of colonization, incidence of infection and risk factors. Acta Anaesthesiol Scand. 2006;50:451-60. DOI: https://doi.org/10.1111/j.1399-6576.2006.00974.x
Brar S, Wang Y, Cannitelli A, Lambadaris M, Li Y, Famure O, et al. Bacteremia in kidney transplant recipients: Burden, causes, and consequences. Clinical Transplantation. 2019; 33:e13479. DOI: https://doi.org/10.1111/ctr.13479
Galindo Sacristán P, Pérez Marfil A, Osorio Moratall JM, de Gracia Guindo C, Ruiz Fuentes C, Castilla Barbosa YA, et al. Predictive factors of Infection in the 1st year after kidney transplantation. Transpl Proc. 2013;45:3620-3. DOI: https://doi.org/10.1016/j.transproceed.2013.11.009
Actividad de donación y trasplante renal. España 2019. Ministerio de Sanidad, Servicios Sociales e Igualdad. [Consultado 04 Jul 2020]. Disponible en: http://www.ont.es/infesp/Memorias/Actividad_de_Donaci%C3%B3n_y_Trasplante_Renal_2019.pdf.
Al-Hasan MN, Razonable RR, Kremers WK, Baddour LM. Impact of Gram-negative bloodstream infection on long-term allograft survival after kidney transplantation. Transplantation. 2011;91(11):1206-10. DOI: https://doi.org/10.1097/TP.0b013e3182180535
Parasuraman R, Abouljoud M, Jacobsen G, Reddy G, Koffron A, Venkat KK. Increasing trend in infection-related death-censored graft failure in renal transplantation. Transplantation. 2011;91(1):94-9. DOI: https://doi.org/10.1097/TP.0b013e3181fdd96c
Skov Dalgaard L, Nørgaard M, Povlsen JV, Morrissey O, Jespersen B, Jensen-Fangel S ,et al. Risk and prognosis of bacteremia and fungemia among first-time kidney transplant recipients: a population-based cohort study. Infect Dis (Lond). 2017 Apr;49(4):286-95. DOI: https://doi.org/10.1080/23744235.2016.1248483
Rodríguez Martínez R, Bacallao Méndez R, Gutiérrez García F, Fonseca Hernández D. Complicaciones del trasplante renal en el Instituto de Nefrología. 2001-2005. Rev Soc Esp Enferm Nefrol. 2010;13(1):7-15. DOI: https://doi.org/10.4321/S1139-13752010000100002
Kritikos A, Oriol M. Bloodstream infections after solid-organ transplantation. Virulence. 2016;7(3):329-40. DOI: https://doi.org/10.1080/21505594.2016.1139279
Silva M, Marra AR, Pereira CA, Medina-Pastana JO, Camargo LF. Bloodstream infection after kidney transplantation: epidemiology, microbiology, associated risk factors, and outcome. Transplantation. 2010;90(5):581-7. DOI: https://doi.org/10.1097/TP.0b013e3181e8a680
Moreno A, Cervera C, Gavalda J, Rovira M, de la Camara R, Jarque I, et al. Bloodstream infections among trasplant recipients: results of a nationwide surveillance in Spain. Am J Trasplant. 2007;7(11):2579-86. DOI: https://doi.org/10.1111/j.1600-6143.2007.01964.x
Al-Hasan MN, Razonable RR, Eckel-Passow JE, Baddour LM. Incidence rate and outcome of gram-negative bloodstream infection in solid organ transplant recipients. Am J Trasplant. 2009;9(4):835-43. DOI: https://doi.org/10.1111/j.1600-6143.2009.02559.x
Tolkoff-Rubin NE, Rubin RH. The infectious disease problems of the diabetic renal transplant recipient. Infect Dis Clin North Am. 1995;9(1):117-30. DOI: https://doi.org/10.1016/S0891-5520(20)30643-7
Moghadamyeghaneh Z, Chen LJ, Alameddine M, Gupta AK, Burke GW, Ciancio G. Never events and hospital-acquired conditions after kidney transplant. Can Urol Assoc J. 2017 Nov;11(11):E431-E436. DOI: https://doi.org/10.5489/cuaj.4370
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16(3):128-40. DOI: https://doi.org/10.1016/0196-6553(88)90053-3
Pujol M, Limón E. Epidemiología general de las infecciones nosocomiales. Sistemas y programas de vigilancia. Enferm Infecc Microbiol Clin. 2013;31(2):108-13. DOI: https://doi.org/10.1016/j.eimc.2013.01.001
US Renal Data System. USRDS. 2011 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda, Maryland: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 2011.
Hernández D, Moreso F. Has patient survival following renal transplantation improved in the era of modern immunosuppression? Nefrología. 2013;33:171-80.
Martorell J. Mecanismos de respuesta inmune e infección. En: Aguado García J, Fortún Abete J, Gavaldá Santapau J, Pahissa Berga A, de la Torre Cisneros J. Infecciones en pacientes trasplantados. 3rd ed. 2009;49-59.
Figueroa-Sánchez GE, Arreola JM, Morales-Buenrostro LE. Factores de riesgo para infección de vías urinarias en el periodo postrasplante renal temprano. Revista Mexicana de Trasplantes. 2012;1(1):22-8.
Cong-Tat C, Ming-Ji L, Chia-Wen L, Nan-Yao L, Shen-Shin C, Ching-Chi L, et al. Community-onset bacteremia in kidney transplant recipients: The recipients fare well in terms of mortality and kidney injury. Journal of Microbiology, Immunology and Infection. 2016;49:685-91. DOI: https://doi.org/10.1016/j.jmii.2014.08.027
García-Prado ME, Cordero E, Cabello V, Pereira P, Torrubia FJ, Ruíz M, et al. Complicaciones infecciosas en 149 receptores de trasplante renal consecutivos. Enferm Infecc Microbiol Clín. 2009;27(1):22-7. DOI: https://doi.org/10.1016/j.eimc.2008.02.004
López-Oliva MO, Flores J, Madero R, Escuin F, Santana MJ, Bellón T, et al. Cytomegalovirus infection after kidney transplantation and long-term graft loss. Nefrologia. 2017 Sep-Oct; 37(5):515-25. DOI: https://doi.org/10.1016/j.nefroe.2016.11.018
O' Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, et al. Guidelines for the Prevention of Intravascular Catheter-Related Infections. Centers for Disease Control and Prevention. MMWR 2002;51(No.RR-10):13-6.
Elliot T, Timsit J-F. EPIC3: Guidelines for preventing infections associated with the use of intravascular access devices. J Hosp Infect. 2014 Jul;87(3):182. DOI: https://doi.org/10.1016/j.jhin.2014.02.014