Ureteral complications after kidney transplantation are frequent and may have a negative impact on morbidity and graft function. Treatment modalities include conservative, endourological, and ...surgical techniques, with variable outcomes. The purpose of this study was to report the incidence, characteristics, treatment, and outcomes of ureteral complications at our center.
Retrospective study of kidney transplants performed at our unit between 2015 and 2020, analyzing incidence, characteristics, treatment, and outcomes of ureteral stenoses and fistulas.
Of 648 kidney transplants, we present 3.24% stenosis and 2.16% ureteral fistulas, with a mean time from transplantation of 101.4 and 24.4 days, respectively. Primary treatment was open surgical repair in 52.4% stenosis and 100% fistulas, with a success rate of 90.9% and 71.4%, respectively. Anterograde balloon dilatations were performed in 33.3% of stenosis with 40% success. Three patients required surgery as a secondary approach with 100% success. Major complications (Clavien-Dindo III) were observed in 18.5% following surgical repair. After a mean follow-up of 31.1 ± 20.9 months, we observe 88.6% of functioning grafts. We found no significant differences in graft survival between patients with or without ureteral complications (p 0.948).
Surgical repair of ureteral complications offers satisfactory results with low associated morbidity. Endourological techniques are less effective and should be reserved for selected cases. With adequate management, there is no impact on graft survival.
Infections related to catheters in the upper urinary tract (CUUT) are associated with specific characteristics.
A prospective observational study was carried out from 2012 to 2015 to evaluate ...infections in patients with CUUT.
A total of 209 infections were included (99 with double-J, 81 with nephrostomy, and 29 with internal/external nephroureteral stents). Among nephrostomy tube carriers, the most frequently isolated microorganisms were Pseudomonas and Enterococcus. In those with an internal/external nephroureteral stent, Klebsiella was the most common, and 57.1% were extended-spectrum beta-lactamase-producing Klebsiella. In double-J carriers, Escherichia coli and Enterococcus were the most common microorganisms. Multiple-drug resistance (MDR) microorganisms were isolated in 28.6, 47.1, and 58.3% of patients with double-J, nephrostomy, and internal-external nephroureteral stents. A percutaneous CUUT (p = 0.005) and immunosuppression (p = 0.034) were risk factors for MDR microorganisms.
Non-E. coli bacteria are commonly isolated in patients with CUUT. MDR microorganisms are frequent, mainly in percutaneous approach or immunosuppression.
To analyze, in a urology ward, the prevalence and characteristics of healthcare-associated infections (HAIs) due to multidrug-resistant organisms (MDRO).
We carried out an observational study from ...2012 to 2019, evaluating MDRO among patients with HAIs, who were hospitalized in the urology ward. MDRO include
spp., resistant to at least three antibiotic groups, extended-spectrum beta-lactamase (ESBL) producing
or those resistant to carbapenems, and
spp. resistant to vancomycin.
Among patients with HAIs, MDRO were isolated in 100 out of 438 (22.8%) positive cultures. Univariate and multivariate analyses reported that prior urinary tract infection (UTI) OR 2.45; 95% CI 1.14-5.36; p=0.021 and immunosuppression OR 2.13; 95% CI 1.11-4.10; p=0.023 were risk factors for MDRO. A high prevalence of MRDO was found in patients with a catheter in the upper urinary tract; 27.6% for double J stent, 29.6% in those with a nephrostomy tube, and 50% in those with a percutaneous internal/external nephroureteral (PCNU) stent. MDRO were isolated in 28.4% of cultures with
(23.8% and 44.7% in those with
and
spp.); 7% of
showed resistance to carbapenems (1.3% and 10% for
and
spp., respectively). Three out of 80
spp. were vancomycin-resistant. The rate of
resistant to at least three antibiotic groups was 36.3%.
The isolation of MDRO, in up to 25% of positive cultures in a urology ward, constitutes a challenge for the selection of antibiotics. MDRO are more common in immunosuppressed patients, those with previous UTIs, and those with a catheter in the upper urinary tract.
Healthcare-associated infections (HAIs) in urological patients have special features due to specific risk factors. Our objective was to evaluate the characteristics and risk factors for HAIs in ...patients hospitalized in a Urology ward.
We evaluated prospectively, from 2012 to 2015, the incidence, types and risk factor for HAIs, microbiological and resistance patterns.
The incidence of HAIs was 6.3%. The most common types were urinary infections (70.5%) and surgical site infections (22.1%). Univariate analysis showed an increased risk of HAIs among patients with American Society of Anesthesiologists physical status classification system III-IV (odds ratio OR, 1.39; p<0.001), immunosuppression (OR, 1.80; p=0.013), previous urinary infection (OR, 4.46; p<0,001), and urinary catheter before admission (OR, 1.74; p<0.001). The surgical procedures with the highest incidence of HAIs were radical cystectomy (54.2%) and renal surgery (8.7%). The most frequently isolated microorganisms were
(25.1%),
spp. (17.5%),
spp. (13.5%) and
(12.3%).
was the most common microorganism after radical cystectomy and in surgical site infections,
showed resistance rates of 53.5% for fluoroquinolones, 9.3% for amikacin. The percentage of extended-spectrum betalactamase producing
was 24.7%.
spp. showed resistance rates of 47.8% for fluoroquinolones, 7.1% for amikacin and 4.3% for carbapenems.
spp showed resistance rates of 1.7% for vancomycin and;
of 33.3% for carbapenems and 26.2% for amikacin.
Comorbidities, previous urinary infections, and urinary catheter are risk factors for HAIs. The microorganisms most commonly isolated were
,
and
. Prospective monitoring may decrease the incidence of infections.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Late kidney transplant complications treatment. Tejido Sánchez, Angel; Pamplona Casamayor, Manuel; Duarte Ojeda, José Manuel ...
Archivos españoles de urología
74, Issue:
10
Journal Article
Peer reviewed
Late kidney transplant complication might compromise graft durability, thus the need for early detection and treatment.
A PubMed review including the following MeSH terms was included: kidney ...transplant¨, ¨complications¨, ¨vascular complications¨,¨transplant renal artery stenosis¨, ¨ureteral obstruction¨,¨urologic complications¨, ¨forgotten stent¨, ¨vesicoureteralreflux¨, ¨urinary lithiasis¨ e ¨incisional hernia¨. Metanalysis and systematic review in spanish and English were included from January 2015 till February 2021, as well as relevant selected manuscripts. RESULTS: We defined as late complications those appearing at 3 months from kidney transplant. Those include vascular complications (renal artery stricture), urinary tract (ureteral stricture, permanent double Js, pyelonephritis due to reflux, urinary stones) and abdominal wall (incisional hernia).
Late kidney transplant complications remain high still with advancement on surgical technique and immunotherapy. Those complication might compromise the graft durability and so early detection is or primary importance.
Our aim was to describe the incidence and risk factors associated with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and their resistance rate in a urological ward.
We carried ...out a prospective observational study from November 2011 to December 2014, reviewing healthcare-associated infections (HAIs) in our department. We evaluated the infections caused by ESBL-producing Enterobacteriaceae.
The incidence of HAIs in our urology ward was 6.8%. Enterobacteriaceae including Escherichia coli (24.9%), Klebsiella spp. (12.1%), Enterobacter spp. (5.9%), Morganella spp. (1.5%), Proteus spp. (1.5%), and Citrobacter spp. (1.5%) represented 47.4% of the isolated pathogens. The percentage of ESBL-producing Enterobacteriaceae was 26.4. Risk factors associated with a higher incidence of ESBL-producing bacteria were prior urinary tract infection (UTI; p < 0.001), hypertension (p = 0.042), immunosuppression (p = 0.004), and urinary stone (p = 0.027). The multivariable analysis confirmed prior UTI, immunosuppression and urinary stone as risk factors. ESBL-producing strains showed resistance rates of 85.3% for fluoroquinolones and 11.8% for carbapenems. Moreover, 16.7% of ESBL-Klebsiella were resistant to carbapenems.
ESBL-producing enterobacteria are associated with higher cross resistance to antibiotics such as quinolones. Higher resistance rates are reported in ESBL-producing Klebsiella. Among patients admitted in a urology ward, risk factors for ESBL-producing strains were previous UTI, immunosuppression, and urinary stone.
Abstract
Objective. Healthcare-associated infections (HAIs) constitute a potentially severe complication which implies higher costs. A full knowledge of their microbiological characteristics and risk ...factors is of paramount importance for adequate management. The purpose of this study was to carry out an analysis of HAIs in patients admitted to a department of urology. Material and methods. Between November 2011 and October 2012, a prospective observational study was carried out analysing HAIs in patients admitted to the urology department of a tertiary care university hospital in Spain, reviewing the incidence and types of HAIs, the microorganisms isolated and patterns of resistance to antibiotics. Risk factors for HAIs were also evaluated. Results. HAIs were seen in 110 (6.5%) out of 1701 patients. Hypertension, a higher American Society of Anesthesiologists (ASA) score and surgery showed a statistical association with a higher risk of HAIs, and patients who underwent radical cystectomy had a high incidence of HAIs (10 out of 14). The most common HAIs were urinary tract infections (66.1%), followed by surgical site infections (16.5%), intra-abdominal abscesses (10.4%) and venous catheter-associated bacteraemia (6.1%). The most frequently isolated microorganisms were Escherichia coli (31.8%), then Enterococcus (17.6%) and Pseudomonas (12.9%). Escherichia coli showed resistance rates of 48.1% for ampicillin/amoxicillin plus β-lactamase inhibitor, 51.9% for fluoroquinolones, and 33.3% were extended-spectrum β-lactamase-producing E. coli. Pseudomonas aeruginosa showed a resistance rate of 36.4% for fluoroquinolones and carbapenems. Conclusions. HAIs usually occur in patients with risk factors. Radical cystectomy is associated with a high incidence of HAIs. Microorganisms associated with HAIs show high rates of resistance, which must be taken into account when selecting appropriate antibiotic therapy.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
To establish the rate of infectious complications derived from the use of transrectal ultrasound-guided prostate biopsy (TRUS), identify its microbiological profile and related risk factors.
We ...designed a prospective non-randomized study in which we enrolled 220 patients undergoing TRUS biopsy at our centre between April and September 2008. The inclusion criteria were: suspicious digital rectal examination, PSA >10 ng/ml, and free/total ratio of PSA is assessed in patients with PSA 4-10 ng/ml. The exclusion criteria were: having an indwelling urinary catheter, the administration of antibiotic treatment in the week before the needle biopsy, manipulation of the urinary tract in the month prior to the needle biopsy, allergy to quinolones and risk of endocarditis, failure to comply with the antibiotic prophylaxis regimen and loss to follow-up. We analyzed the relationship between diabetes, immunodepression, previous UTI or prostatitis and positive prebiopsy urine culture with the appearance of fever, dysuria or bacteriuria following needle biopsy.
Mean age was 69.5 years (+/-7.9), mean total PSA 12.7 ng/ml (+/-28.7), mean prostate volume 50.6 cc (+/-29.6) and mean number of cores obtained by needle biopsy 13.5 (+/-1.7). 25% of the patients had dysuria following needle biopsy, 3.2% fever and 4.5% bacteriuria. E.coli was the pathogen most frequently found in pre- and post-biopsy urine cultures. No statistically significant relationship was found between the appearance of dysuria and fever and being diabetic, having immunosuppression, previous UTI or prostatitis, prostate volume and number of cores obtained in the biopsy. Only the existence of a positive pre-biopsy urine culture and biopsy with more than 14 cores proved to have a statistically significant association with the existence of bacteriuria following biopsy, p=0.007 and p= 0.018, respectively.
Our rate of infectious complications was similar to that described in other series. The existence of a positive prebiopsy urine culture and obtaining more than 14 cores per biopsy was related, with statistical significance, to the existence of bacteriuria following the biopsy. E.coli was the most frequently isolated pathogen.
To review the incidence of healthcare-associated infections/urinary tract infection (UTI), risk factors, microorganisms isolated and antibiotic resistances in patients who underwent lower urinary ...tract endoscopic surgery (LUTES) in a tertiary care hospital.
A prospective observational study was carried out including 1,498 patients who undergo LUTES. Patients with and without UTI after surgery were compared. We analysed infection incidence, risk factors, microorganisms isolated and antibiotic resistances.
Postoperative UTI incidence was 4.7%. Risk factors found: higher American Society of Anesthesiologists classification (OR 2.82; 95% CI 1.8-4.5; p < 0.00), immunosuppression (OR 2.89; 95% CI 1.2-7.2; p = 0.01), indwelling urinary catheter prior admission (OR 2.6; 95% CI 1.6-4.2; p < 0.00) and postoperative catheterization longer than 2 days (OR 1.74; 95% CI 1.7-4.3; p < 0.00). Transurethral resection of the bladder (TURB) had the highest infection rates (5.5%). Microorganisms isolated were Pseudomonas aeruginosa (23.5%), Escherichia coli (17.6%), Klebsiella pneumoniae and Enterococcus spp (11.8%). Resistance rates for flourquinolones varied between 28 and 80%, and Carbapenem-resistant Enterobacteriaceae rose up 20%.
Low percentage of UTI after endoscopic surgery was registered. TURB was the procedure with highest infection rate. Pseudomonas aeruginosa stands out as the most frequently isolated microorganism. Patient comorbidities, previous urinary catheter and postoperative catheter were identified as risk factors.
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