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Infectious complications after kidney transplantation: current epidemiology and associated risk factors
Author(s) -
Alangaden George J,
Thyagarajan Rama,
Gruber Scott A.,
Morawski Katherina,
Garnick James,
ElAmm Jose M.,
West Miguel S.,
Sillix Dale H.,
Chandrasekar Pranatharthi H.,
Haririan Abdolreza
Publication year - 2006
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2006.00519.x
Subject(s) - medicine , thymoglobulin , transplantation , trimethoprim , kidney transplantation , basiliximab , cefazolin , tacrolimus , surgery , gastroenterology , immunology , antibiotics , microbiology and biotechnology , biology
Background: The impact of newer immunosuppressive and antimicrobial prophylactic agents on the pattern of infectious complications following kidney transplantation has not been well studied. Methods: This is an observational study in 127 adult recipients transplanted from 2001 to 2004. Patients received thymoglobulin (ATG) (50%) or basiliximab (50%) for induction and were maintained on mycophenolate mofetil, either tacrolimus (73%) or sirolimus (SRL) (27%), and prednisone (79%). Antimicrobial prophylaxis included perioperative cefazolin, trimethoprim/sulfamethaxazole for six months, valganciclovir for three months and nystatin for two months. Regression models were used to examine the association of various factors with infections. Results: We observed 127 infections in 65 patients, consisting of urinary tract infection (UTI) (47%), viral infections (17%), pneumonia (8%) and surgical wound infections (7%). UTI was the most common infection in all post‐transplant periods. Enterococcus spp. (33%) and Escherichia coli (21%) were the most prevalent uropathogens. Of six patients with cytomegalovirus infection, none had tissue‐invasive disease. There were no cases of pneumocystis pneumonia or BK nephropathy. Six patients developed fungal infections. Two deaths due to disseminated Rhizopus and Candida albicans accounted for a 1.5% infection‐related mortality. Retransplantation and ureteral stents were independently associated with UTI (OR = 4.5 and 2.9, p = 0.06 and 0.03, respectively), as were ATG and SRL with bacterial infections (OR = 3.3 and 2.5, p = 0.009 and 0.047, respectively). Conclusion: This study suggests that the use of newer immunosuppressive agents in recent years is associated with some changes in the epidemiology of post‐transplant infections. Enterococci have become the predominant uropathogen. Invasive fungal infections, although rare, are often fatal.