[Types of infectious complications exciters in recipients of related kidneys].

AIM: To investigate the nature of microflora causing an infectious-inflammatory complications in recipients of related kidney in the early postoperative period and to substantiate the effectiveness of antibiotic prophylaxis and antibiotic therapy depending on pathogen type with the determination of its sensitivity to antimicrobial agents. MATERIAL AND METHODS: The medical records of 255 patients who underwent kidney transplantation from a living related donor from 2007 to 2014 were analyzed. Foci of infection were sanitized preoperatively to prevent infectious complications in post-transplantation period. Immunosuppression induction was achieved using 2-fold administration of Kempas or Simulect. Corticosteroids, ciclosporin, prograf, advagraf, myfortic, neoral, sertican were used for routine immunosuppression. Complications after kidney transplantation were detected in 65 (25.5%) patients including 38 (14.9%) infectious and 27 (10.6%) non-infectious complications. The material for microbiological examination included blood, urine, sputum, wound discharge, bronchial lavage. Extraction and identification of microorganisms were carried out according to conventional techniques as well as using automatic Vitec-2 Compact analizer («BioMeriex¼, France). Sensitivity to antibiotics was determined using Vitek-2 Compact analyzer. The functional aspects of transplanted kidney were studied in 255 patients. Normal and decreased function of kidney was observed in 221 (86.6%) and 30 (11.8%) cases respectively. Transplantant did not function in 4 (1.57%) patients. RESULTS: The probability of infection is highest in the early postoperative period. Risk factors were inadequate and prolonged antibiotic therapy, unrecognized infection postoperatively. The main problem in renal transplant recipients is urinary tract infection (90% of patients).

[Infectious complications after kindred kidney allotransplantation].

It was analyzed the medical records of 231 patients who underwent living kindred donor kidney transplantation. Early postoperative complications were observed in 51 (22%) patients including infectious events in 30 cases namely pyelonephritis (13), pneumonia (6), sepsis (5), wound infection (3), pulmonary tuberculosis (2) and esophageal mycosis (1). Microflora investigation revealed predominantly gram-negative bacteria including enterobacteriaceae (K. pneumoniae, E. coli and E. cloacae) and nonfermentable bacteria (P. aeruginosa, Acinetobacter spp.). Analysis of 7-year antibiotic susceptibility showed that polymyxin, imipenem, cefoperazone/sulbactam and amikacin preserve their activity against enterobacteriaceae and pseudomonas; linezolid, vancomycinum and moxifloxacin--against staphylococcus; voriconazole, amphotericinum B and fluconazole--against Candida spp. These medicines are preferred for antibiotic prevention of perioperative and early postoperative infectious complications.

[Clinical and bacteriological characteristic of infectious purulent complications in patients after related renal transplantation].

We investigated the frequency and characteristics of infectious purulent and non-infectious complications in living related renal transplant recipients in early postoperative period. It was identified the prevalent microorganisms in urinary tract infections and its antibiotic sensitivity: Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Citrobacter freundii, Staphylococcus epidermidis, Enterococcus faecalis, Candida albicans. 182 strains of bacteria and Candida were isolated from urine of renal graft patients in early postoperative period (from 2 days to 3 months). The prevention and treatment schemes, antimicrobial drugs dosing regimen were developed. It leads to decrease the infectious complications rate.

[Nosocomial infectious complications after transplantation of allogenic kidneys from the related donor].

The comprehensive evaluation of infectious complications after kidney transplantation from the living related donor was performed. Microbes predominantly encountered in urinary tract infection (P. aeruginosa, K. pneumoniae, E. coli, E. cloacae, S. epidermidis, E. faecalis) were studied. Prevention patterns and dosing regimens for the antibacterial therapy were developed considering data from the retrospective analysis of the isolated flora and its resistance. This resulted in the reduced rate of infectious complications.

[Rational prophylaxis and treatment of infectious complications in kidney transplantation].

Clinical and bacteriological assessment of purulent complications in kidney transplantation has been carried out. The main infectious agents were S. epidermalis, E. coli, E. faecalis. Based on these data the optimal antibiotic therapy has been used that permitted to reduce the rate of infectious complications from 41 to 25.3%.

[Pyogenic infectious complications in recipients with allogenic kidneys: clinical and bacteriological aspects]. / Infektsionno-gnoinye oslozhneniia u retsipientov allogennykh pochek (klinicheskie i bakteriologicheskie aspekty).

The bacteriological study of wound discharge indicated no changes in the structure of the microflora in the allogenic kidneys of recipients throughout the follow-up. Among microbes isolated there were prevalent gram-positive microbes whose proportion has slightly increased in the past year, with Staphylococcus, mainly epidermal Staphylococcus, which contributes to the etiology. At the same time, studies of wound discharge in the past years showed that the incidence of mixed infections had increased from 4.3 in 1989-1991 to 15.6% in 1994-1997. Bacteriological urinalysis found no great differences in the etiological structures of the microflora. Gram-negative microbes are prevalent in all patients in three periods of follow-up. Noteworthy, there was an increase in the amount of yeast fungi (from 5.7 to 21.1%). Urinalysis showed that the rates in the isolation of bacterial and bacterial and fungal associations were steady-state and higher in all patients (20, 4-23, 5%). Examining the etiological structure of the pathogens of sepsis ascertained that patients of the early observation were found to isolate gram-negative microorganisms more frequently, while those of other observation periods have gram-positive ones. The overall proportion of microbial and microbe-fungal associations was 10.3% in the past 9 years. Since the patient's body is occupied by other pathogens due to immunosuppression, sepsis or wound infection was accompanied by high bacteriuria, cytomegalovirus infection, pneumocystic pneumonia, fungal infection, etc. For this reason, the patients had actually much higher quantities of mixed infections in sepsis, wound infection, or urinary infection than those taken into account while studying the only type of an infectious complication. The above leads to the conclusion that the incidence of mixed infection of recipients of allogenic kidneys is rather high. This infection substantially makes the choice of drugs and therapy difficult, the course of a wound process aggravated. For successful control of mixed infections, it is necessary to introduce new drugs having a high activity against bacteria, fungi, viruses, and protozoa and to use the latest differentially diagnostic culture media, to make diagnosis and treatment of pyoseptic diseases better.

[Hypertension syndrome in kidney transplantation]. / Sindrom gipertenzii pri transplantatsii pochki.

Removal of the recipient's own kidney is indicated in cases with non-controlled arterial hypertension before and after transplantation of the kidney with the exclusion of chronic rejection and stenosis of the transplant artery. Embolization of the renal arteries is indicated to patients of high surgical risk. Roentgen-endovascular catheter dilatation of the stenosed artery of the transplanted kidney allows the operative treatment of recipients with chronic rejection of the transplant to be avoided. Surgical correction of stenosis is indicated to patients with a short-term hypotensive effect after dilatation.