Infección urinaria por enterobacterias multirresistentes en un centro de trasplante renal / Urinary Tract Infection by Multiresistant Enterobacteriaceae in a Renal Transplant Center

La infección bacteriana del tracto urinario (ITU) es la cau-sa más frecuente de complicación en el paciente trasplantado renal. Nuestros objetivos fueron determinar los patógenos mas frecuentes, su asociación al tiempo transcurrido al primer episodio de ITU, los factores de riesgo predisponentes y la sensibilidad antibiótica de los gérmenes.Materiales y Métodos: se realizó un estudio retrospectivo en el que se siguió por un año a los pacientes trasplantados renales entre noviem-bre de 2006 a febrero de 2012. Se incluyó el primer urocultivo positivo con bacilos gram negativos. Resultados: de 156 pacientes analizados, 63 (40 %) tuvieron al menos un episodio de ITU en el que se caracterizaron los microorganismos responsables. El patógeno más frecuente fue Klebsiella pneumoniae(25/63 episodios, 39 %), seguido por Escherichia coli (23/63, 37 %). Casi la mitad (31/63, 49 %) ocurrieron antes de los 30 días (58 % por K. pneu-moniae), un tercio (18/63, 29 %) entre los 31 y 180 días (39 % por E. coli) y el resto (14/63, 22 %) en el medio año siguiente (64 % de ellas cau-sadas por E. coli). Entre las K. pneumoniae, 22/25 (88 %) resultaron productoras de ß lactamasas de espectro extendido. Como factores de riesgo predisponentes se encontraron sexo femenino, litiasis renal previa y utilización de catéter doble J. Conclusión: este estudio confirma que las ITU son una complicación frecuente en los transplantados renales. La asociación de K. pneumo-niae multirresistentes con las infecciones inmediatas puede ser consi-derada como marcadora de infección intrahospitala-ria, y señala la posibilidad de realizar intervenciones que modifiquen su incidencia

Urinary tract infections (UTI) are the most frequent complication in renal transplant patients. Our aims were to determine the most common pathogens, the association of different enterobacterias with the time of the onset of the infection, the impact of several risk factors and antibiotic susceptibility.Materials and Methods: The patients were monitored for a year after the renal transplant from November 2006 to February 2012. A retrospective analysis was done and the first positive urine culture with gram negative bacilli was included.Results: From a total of 156 patients analyzed, 63 (40%) had at least one experience of UTI in which the responsible microorganisms were characterized. The most common pathogen was Klebsiella pneumoniae (25/63 episodes, 39 %), followed by Escherichia coli (23/63, 37 %). Almost half of the cases (31/63, 49%) occurred within 30 days (58% for K. pneumoniae), one third of them (18/63, 29%) between 31 and 180 days (39% for E. coli) and the remainings (14/ 63, 22%) in the next half year (64% of them caused by E. coli). Most of the K. pneumoniae, (22/25, 88%) were extended spectrum ß lactamases producers. We can mention as predisposing risk factors: female gender, lithiasis and urinary stent presence. Conclusion: This study confirms that UTIs are a frequent complication in renal transplantation. The association of multiresistant K. pneumoniae infections with immediate UTI can be considered as a marker of nosocomial infection, and points out intervention as a possibility to modify this impact

Pandemic influenza A/H1N1 virus infection in solid organ transplant recipients: a multicenter study.

BACKGROUND: The 2009 novel influenza A/H1N1 virus pandemic did not spare solid organ transplant (SOT) recipients. We aimed to describe the behavior of pandemic influenza infection in a group of SOT recipients in Argentina. METHODS: Data from 10 transplant (Tx) centers were retrospectively collected for SOT that presented with a respiratory illness compatible with pandemic influenza A infection, between May and September 2009. Cases were defined as suspected, probable, or confirmed according to diagnostic method. RESULTS: Seventy-seven cases were included. No significant differences in presenting symptoms, pulmonary infiltrates, and graft involvement were found among 35 suspected, 19 probable, and 23 confirmed cases. The 33 ambulatory cases had significantly more sore throat and headache when compared with 34 cases admitted to medical ward (MW) and 10 admitted to intensive care unit (ICU), 9 of whom required ventilatory support. MW and ICU cases had significantly more dyspnea, hypoxemia, pulmonary infiltrates, and graft dysfunction. Time from onset of symptoms to first visit and to treatment was significantly longer in MW and ICU cases (P=0.008). Coinfections were found in six cases. Most cases received oseltamivir for 5 to 10 days. Six patients (7.8%) died from viral infection at a median of 15 days from admission. No differences in outcome were seen related to the transplanted organ, the immunosuppressive regimen, time from Tx, or confirmation of diagnosis. CONCLUSIONS: Mortality is higher in Tx recipients than in the general population. Poor outcome seems to be related to a delay in the beginning of treatment.