Home About us Editorial board Ahead of print Browse Articles Search Submit article Instructions Subscribe Contacts Login 
  • Users Online: 427
  • Home
  • Print this page
  • Email this page


 
Previous article Browse articles Next article 
REVIEW ARTICLE
J Res Med Sci 2021,  26:26

Overview on urinary tract infection, bacterial agents, and antibiotic resistance pattern in renal transplant recipients


1 Department of Infectious Disease, Hainan General Hospital, Haikou, Hainan 570311, China
2 Infectious Diseases Research Center; Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran

Date of Submission29-Apr-2018
Date of Decision05-May-2020
Date of Acceptance25-Oct-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Mr. Hui Gao
Department of Infectious Disease, Hainan General Hospital, Haikou, Hainan 570311
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrms.JRMS_286_18

Rights and Permissions
  Abstract 


Background: Urinary tract infection (UTI) is a mainly common infection in kidney transplant recipients. This study decided to investigate UTI, bacterial agents, and antibiotic resistance pattern in kidney transplant recipients from Iran. Materials and Methods: Search process was conducted for UTI, bacterial agents, and antibiotic resistance pattern in kidney transplant recipients from Iran via electronic databases (Scopus, PubMed, Web of Science, etc.,) with Mesh terms in either Persian and English languages without limited time to May 31, 2020. Data were analyzed by comprehensive meta-analysis software. Results: The combined prevalence of UTI in renal transplant recipients was reported by 31.1%. The combined prevalence of Gram-negative bacteria was 69%. The most common pathogens among Gram negatives were E. coli followed by Klebsiella pneumoniae with frequency 43.4% and 13%, respectively. Subgroup analysis for Gram-positive bacteria showed the combined prevalence of 31%. The most common microorganism among Gram positives belonged to coagulase-negative Staphylococci and Enterococci with a prevalence of 10.2% and 9%, respectively. Subgroup meta-analysis of antibiotic resistance for Gram-negative showed the most resistance to cephalexin followed by carbenicillin with a prevalence of 89.1% and 87.3%, respectively. Conclusion: Our review showed a noticeable rate of UTI (31.1%) among renal transplant recipients in Iran and a high prevalence of Gram-negative (69%) and Gram-positive (13%) microorganisms. A high resistance rate was seen against almost all antibiotics used for the treatment of UTI. Therefore, empirical prescription of antibiotics should be avoided, and it should be based on data obtained from antibiogram tests.

Keywords: Antibiotic resistance, bacteriuria, kidney grafting, renal transplantation, urinary tract infection


How to cite this article:
Zhang X, Gao H, Fu J, Lin F, Khaledi A. Overview on urinary tract infection, bacterial agents, and antibiotic resistance pattern in renal transplant recipients. J Res Med Sci 2021;26:26

How to cite this URL:
Zhang X, Gao H, Fu J, Lin F, Khaledi A. Overview on urinary tract infection, bacterial agents, and antibiotic resistance pattern in renal transplant recipients. J Res Med Sci [serial online] 2021 [cited 2021 Dec 1];26:26. Available from: https://www.jmsjournal.net/text.asp?2021/26/1/26/312789




  Introduction Top


As we know kidney transplantation despite the high cost is clinically effective treatment for the end-step renal disorder,[1] nowadays, it is possible with a profitable kidney transplant increases quality of life in patients and decreases mortality.[2] Posttransplant complications are produced such as dialysis and the altered anatomy of the urogenital tract.[2],[3]

The main cause of mortality and morbidity in kidney transplant recipients is bacterial infection.[4] Urinary tract infection (UTI) is mainly a common infection in kidney transplant recipients.[5],[6] In original, bacteriuria categorizes into two types: asymptomatic bacteriuria (ASB) and symptomatic UTI.[7] ASB is defined as the growth of bacteria with >105 CFU/mL, wherein the patients do not have any symptoms of infection.[8] Based on recent reports, treatment of ASB might not be required and there was no adverse side effect on transplant outcomes.

UTI is defined by the overgrowth of bacteria >105 CFU/mL from patients' urine samples alongside with symptoms including dysuria, suprapubic, flank or allograft pain, fever, or chills.[8] There are a lot of risk factors for susceptibility to UTI such as acute rejection, female sex, older age, longer durations with a urinary catheter, episodes, and receiving a kidney from a deceased donor.[9]

Organisms that cause UTI post renal transplantation are bacterial, fungal, viral, parasitic, or mycoplasmal.[10] The order of bacterial UTI pathogens in transplant recipients is comparable to that in the nontransplantation population; Gram-negative bacteria are responsible for over 70% of UTI cases.[11],[12] The high frequent bacterial agents causing UTI are Escherichia coli, K. pneumoniae, Enterococcus sp., Enterobacter, Pseudomonas aeruginosa, and Proteus mirabilis.[13],[14]

In some cases, microorganisms that are not problematic in immunocompromised patients have been involved in posttransplantation UTI.[15] This possibly due to immunosuppressant drugs used in these patients, which accelerates bacterial–urothelial adherence.[16] Hence, resistant bacterial strains can cause the problem to patients.[17]

UTI via the inflammatory cytokine response, free-radical production, CMV reactivation, precipitation of rejection, and pyelonephritis-induced renal scarring can impair graft function.[15] It is debatable that how much UTI can affect transplant function and patient survival. However, many retrospective studies have found no significant association between UTI, transplantation, and patient survival.[18]

Concerning the importance of bacterial UTI in renal transplant recipients, and increasing their antibiotic resistance, this study decided to evaluate UTI, bacterial agents, and antibiotic resistance pattern in renal transplant recipients from Iran through systematic review and meta-analysis.


  Materials and Methods Top


Strategy search

Prisma protocol (PRISMA, http://www.prisma-statement.org) was used for searching UTI, the prevalence of microorganisms, and antibiotic resistance pattern in kidney transplant recipients from Iran in both international and national online electronic databases such as Scopus, PubMed, Cochrane Library, Web of Sciences, Iranmedex (www.iranmedex.com), Magiran (www.magiran.com), and Scientific Information Database (www.sid.ir). Mesh terms and text words were urinary tract infection, UTI, kidney transplant, renal transplant, post kidney transplant, antimicrobial drug resistance, and antibiotic resistance pattern. Published studies were searched without time limitation until May 31, 2020.

Inclusion and exclusion criteria

Cross-sectional, cohort, and case–control studies addressing the prevalence of UTI, bacterial pathogens, and antibiotic resistance pattern in renal transplant recipients were enrolled in the current systematic review and meta-analysis. Different types of review articles (systematic, narrative review, and met-analysis), studies with missed data, conferences, meetings, abstracts, and studies published in languages other than English or Persian were excluded. Studies introduced other than kidney transplants were excluded from the study. Of note, two reviewers conducted searches independently.

Assessment of selection bias and quality of selected studies

To achieve this purpose, the criteria given in Critical Appraisal Skills Programmed checklists (www.casp-UK) were used. Hence, 10 questions were asked and if the answer was yes, one point would be considered, and if the answer was no, or if there was any doubt, the score would be 0. At the end, according to the scoring system, strong studies scored above 8, average studies between 5 and 8, and weak studies obtained scores below 4 (file 1).

Data extraction

By use of extract forms, the following data extracted: the first author's name, time of the study, publication year, settings, sample size, prevalence of UTI, Genus, and mean age.

Statistical analysis

Comprehensive meta-analysis software was used for data analysis. The prevalence of UTI, antibiotic resistance, and bacterial agents was calculated by 95% confidence intervals. Due to the existence of heterogeneity among studies, a random effects model was used. I2 and the Q-statistic tests were used for the assessment of heterogeneity among studies included in the present review. P < 0.05 of Q-test and I2 test >50% was considered statistically significant.

In this study, we evaluated the publication bias visually through the Funnel plot. If the distribution of articles is evenly placed inside the funnel, it indicates that there is no publication bias, and if they placed outside the funnel or there is a heterogeneous and unbalanced distribution inside the funnel, it indicates the presence of bias in the study publication. In addition to the Funnel plot, the statistical Egger's linear regression test was used to further investigate publication bias. According to this test, if the P < 0.05, it indicates the existence of publication bias; otherwise, if it is greater than this value, it indicates the absence of publication bias in the studies included.[19] Finally, subgroup analysis was made for bacterial species and antibiotic resistance.


  Results Top


Selection study and features

The selection process is shown in [Figure 1]. Totally, 819 articles potentially were identified, 18 out of which met inclusion criteria for enrollment in the present systematic review and meta-analysis. Most studies were from Tehran (N = 7), followed by Mashhad (N = 4). Patients had mean age of 5–87 years [Table 1]. Most studies had cross-sectional design and 2 studies were case control.
Figure 1: Chart of selection process for included studies

Click here to view
Table 1: Characteristics of enrolled studies for this systematic and meta-analysis

Click here to view


Overall effects

According to the findings obtained from the systematic review and meta-analysis which are shown in [Figure 2] and [Table 2], the combined prevalence of UTI in renal transplant recipients was reported by 31.1% (95% Cl: 24.1–39.1), Z = 4.4, Q = 538, I2 = 96.8.
Figure 2: Forest plot of the meta-analysis on prevalence of urinary tract infection among kidney transplant recipients in Iran

Click here to view
Table 2: Subgroup meta-analysis for both Gram-positive and negative bacteria

Click here to view


Publication bias

Regarding the Funnel plot [Figure 3], because there was a heterogeneous and unbalanced distribution inside the funnel, and studies placed outside the funnel, it indicated the presence of bias in the publication. To further evaluation, the statistical Egger's Linear Regression Test was used; however, the findings showed no publication bias in the studies included, because P = 0.29 [Table 2].
Figure 3: Funnel plot for meta-analysis on prevalence of urinary tract infection among kidney transplant recipients in Iran. Because there is a heterogeneous and unbalanced distribution inside the funnel, and studies placed outside the funnel, it indicates the presence of bias in the study publication

Click here to view


Subgroup analysis for Gram-negative bacteria

As listed in [Table 2], subgroup analysis showed that the combined prevalence of Gram-negative bacteria was 69% (95% Cl: 23.6–99.5), Z = 11, Q = 201 and I2 = 94. The most common pathogens among Gram negatives were E. coli followed by K. pneumoniae with frequency 43.4% (95% Cl: 38.4–50.1), and 13% (95% Cl: 7–19.9), respectively. Furthermore, the least rate belonged to Acinetobacter baumannii with a prevalence of 3% (95% Cl: 1.4–5.8).

Subgroup analysis for Gram-positive bacteria

Subgroup analysis for Gram-positive bacteria showed the combined prevalence of 31% (95% Cl: 12.2–48.4), Z = 5.7, Q = 65.1 and I2 = 90.8. The highest predominant microorganism among Gram positives belonged to coagulase-negative staphylococci (CoNS) and Enterococci with a prevalence of 10.2% (95% Cl: 5.4–18.2) and 9% (95% Cl: 4-3.9), respectively.

Subgroup analysis for antibiotic resistance

Subgroup meta-analysis of antibiotic resistance for Gram-negative bacteria showed the most resistance to cephalexin followed by carbenicillin and ceftazidime with the prevalence of 89.1% (58.8, 102), 87.3% (58.8, 99.3), and 86.3% (47.4, 88.6), respectively. The least resistance was observed against imipenem with a resistance rate of 13% [Table 3]. Furthermore, based on the data summarized in [Table 4], the highest resistance of Gram-positive bacteria reported against amoxicillin and cephalexin with a resistance rate of 79% (38.1,96) and 74% (33.4,98.91), respectively. The effective antibiotic for treatment of Gram-positive bacteria was reported Polymyxin B (10.6%). Findings of antibiotic resistance for E. coli in [Table 5] showed the highest resistance against cotrimoxazole and nalidixic acid with a resistance rate of 74.1% and 70%, respectively. As well, the best antibiotics for treatment of UTI caused by E. coli were reported imipenem and nitrofurantoin with resistance rates of 13.2% and 19%, respectively.
Table 3: Subgroup meta-analysis of antibiotic resistance pattern for Gram-negative bacteria

Click here to view
Table 4: Subgroup meta-analysis of antibiotic resistance for Gram-positive bacteria

Click here to view
Table 5: Subgroup meta-analysis of antibiotic resistance for Escherichia coli isolates

Click here to view



  Discussion Top


In total, UTI is considered as the most common infection and the most possible site of infection that leads to hospitalization of patients with kidney transplantation.[20] The prevalence of UTI in kidney transplant recipients is similar in both developed and developing countries.[5] The prevalence of posttransplant UTI in the kidney transplant recipients varies between 12% and 75%.[21] Of course, in developing countries, this rate may be higher due to epidemiological exposure and lower standards of hygiene.[22] A meta-analysis conducted in 2016 showed that the USA had a significantly higher prevalence of UTIs than European countries (41% vs. 33%).[9]

In the present systematic review and meta-analysis, the combined prevalence of UTI in renal transplant recipients was reported by 31.1%. The combined prevalence of Gram-negative bacteria was 69%. The most common pathogens among Gram negatives were E. coli followed by K. pneumoniae with frequency 43.4% and 13%, respectively. Furthermore, the least rate belonged to A. baumannii with prevalence of 3%. Furthermore, subgroup analysis for Gram-positive bacteria showed the combined prevalence of 31%. The highest predominant microorganism among Gram-positives belonged to CoNS and Enterococci with prevalence 10.2% and 9%, respectively.

The prevalence in Iranian studies included in the current review varied from 4.5% to 67.5%. Our result (31.1% UTI's prevalence) was in line with our studies conducted in other parts of the world such as Turkey,[22] Pakistan,[23] Australia,[24] and the USA.[25] Similar findings in other studies support the concept that UTI still is the most predominant infection postrenal transplantation.[24] The difference in the prevalence of UTI (4.5%–67.5%) in studies included in the present review and other studies from worldwide likely attributed to differences in the definition of UTI, the interval of follow-up, antibiotic prophylaxis used posttransplantation, and inherent differences of the person features among diverse countries.[9]

Similar to our study, others reported the Gram-negative bacteria as the most common organisms isolated from UTI samples of both the nontransplant and transplant patients with the prevalence of 90%.[10],[24] We reported E. coli followed by K. pneumonia as the most prevalent Gram-negative bacteria, as other reports confirm it.[26] In line to our study, a study conducted by Senger et al. in 2003, Enterococcus, Staphylococcus, and Streptococcus reported as the highest frequent bacteria.[26] Similarly, Al Midani et al. from the UK,[27] Camargo et al. from Brazil,[28] Bodro et al. from Spain,[29] reported E. coli and K. pneumonia as the most frequent Gram-negative bacteria. As well, Ediriweera et al. from Sri Lanka reported CoNS as the most Gram+,[30] Wang et al. from Taiwan,[31] Chuang et al. from the USA reported Enterococcus species as the most common Gram-positive bacteria recovered from UTI samples of kidney transplant recipients.[32] All studies mentioned are inconsistent with our findings.

Several studies have confirmed that UTI is related to transplant function failure, particularly in the early posttransplant episode,[6],[29],[33] but others have not reported such association,[34],[35],[36] Additionally, another one found no profit of antibiotic prophylaxis on transplant function in the first 6 months post transplantation.[37] Recently, some studies have shown a rising prevalence of infections caused by Multi-drug-resistant (MDR) strains in both immunocompetent and immunocompromised patients. As several reports presented a high rate of infections are produced by MDR organisms in solid organ recipients, ranging from 6.5% to 56%.[38],[39],[40],[41]

In the present review, subgroup meta-analysis of antibiotic resistance for Gram-negative microorganisms showed the most resistance to cephalexin followed by Carbenicillin and Ceftazidime with the prevalence of 89.1%, 87.3%, and 86.3%, respectively. The least resistance was observed against Imipenem with resistance rate of 13%. Furthermore, the highest resistance of Gram-positive bacteria reported against amoxicillin and cephalexin with resistance rate of 79% and 74%, respectively. The effective antibiotic for the treatment of Gram-positive bacteria was reported Polymyxin B (10.6%). Findings of antibiotic resistance for E. coli showed the highest resistance against Cotrimoxazole and Nalidixic acid with resistance rate of 74.1% and 70%, respectively. As well, the best antibiotic for treatment of UTI caused by E. coli was reported Imipenem and Nitrofurantoin with resistance rate of 13.2% and 19%, respectively.

To our knowledge, ampicillin or amoxicillin were used as the standard treatment for UTI, but various studies from around the world show increased resistance to ampicillin and oxacillin.[42],[43],[60] In agreement with their results, our results showed high resistance against oxacillin in both Gram-negative (76%) and Gram-positive microorganisms (79%), respectively.

Taking into account all these considerations, renal transplant recipients are at high risk for infections caused by MDR strains owing to surgical procedure, long stay in intensive care unit, having underlying diseases, and immunocomponent conditions.[41] Therefore, infection control measures have a positive impact on the prevention of UTI after renal transplantation.

Finally, findings from this systematic review and meta-analysis showed that the best antibiotics against Gram-negative bacteria were imipenem. Polymyxin B was an effective antibiotic against Gram-positive microorganisms; also, imipenem and nitrofurantoin can be used as the first and second-line treatments of pathogenic E. coli isolated from UTI in kidney transplant recipients.


  Conclusions Top


Our systematic review and meta-analysis by combining data from previously published studies in Iran showed a noticeable rate of UTI (31.1%) among renal transplant recipients. As well as, a high prevalence of Gram-negative (69%) and Gram-positive (13%) microorganisms was observed, where E. coli (43.4%) and CoNS (10.2%) were the most among Gram-negative and Gram-positive bacteria, respectively. A high resistance rate was seen against almost all antibiotics used for the treatment of UTI caused by both Gram-negative and Gram-positive bacteria, too. Hence, arbitrary and long-term treatment and empirical prescription should be avoided. Therefore, the antibiotics prescription should be based on data achieved from antibiotic susceptibility tests.

Acknowledgments

We would like to thank our colleagues for their help in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pascual M, Theruvath T, Kawai T, Tolkoff-Rubin N, Cosimi AB. Strategies to improve long-term outcomes after renal transplantation. N Engl J Med 2002;346:580-90.  Back to cited text no. 1
    
2.
Hartono C, Dadhania D, Suthanthiran M. Noninvasive diagnosis of acute rejection of solid organ transplants. Front Biosci 2004;9:145-53.  Back to cited text no. 2
    
3.
Hollyer I, Ison MG. The challenge of urinary tract infections in renal transplant recipients. Transpl Infect Dis 2018;20:e12828.  Back to cited text no. 3
    
4.
Kinnunen S, Karhapää P, Juutilainen A, Finne P, Helanterä I. Secular trends in infection-related mortality after kidney transplantation. Clin J Am Soc Nephrol 2018;13:755-62.  Back to cited text no. 4
    
5.
Mihankhah A, Khoshbakht R, Raeisi M, Raeisi V. Prevalence and antibiotic resistance pattern of bacteria isolated from urinary tract infections in Northern Iran. J Res Med Sci 2017;22:108.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Nickavar A, Sotoudeh K. Treatment and prophylaxis in pediatric urinary tract infection. Int J Prev Med 2011;2:4-9.  Back to cited text no. 6
    
7.
Fernández-Ruiz M, López-Medrano F, Romo EM, Allende LM, Meneu JC, Fundora-Suárez Y, et al. Pretransplant lymphocyte count predicts the incidence of infection during the first two years after liver transplantation. Liver Transpl 2009;15:1209-16.  Back to cited text no. 7
    
8.
Parasuraman R, Julian K, AST Infectious Diseases Community of Practice. Urinary tract infections in solid organ transplantation. Am J Transplant 2013;13 Suppl 4:327-36.  Back to cited text no. 8
    
9.
Wu X, Dong Y, Liu Y, Li Y, Sun Y, Wang J, et al. The prevalence and predictive factors of urinary tract infection in patients undergoing renal transplantation: A meta-analysis. Am J Infect Control 2016;44:1261-8.  Back to cited text no. 9
    
10.
Valera B, Gentil MA, Cabello V, Fijo J, Cordero E, Cisneros JM. Epidemiology of urinary infections in renal transplant recipients. Transplant Proc 2006;38:2414-5.  Back to cited text no. 10
    
11.
Burgos Revilla FJ, Pascual Santos J, Marcén Letosa R, Gómez Do Santos V, Sánchez-Encinas M, Escudero Barrilero A. [Renal transplantation and urinary infection. Review]. Actas Urol Esp 1999;23:95-104.  Back to cited text no. 11
    
12.
Pelle G, Vimont S, Levy P, Hertig A, Ouali N, Chassin C, et al. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Trans 2007;4:899-907.  Back to cited text no. 12
    
13.
Gozdowska J, Czerwińska M, Młynarczyk G, Kwiatkowski A, Chmura A, Durlik M, editors. Urinary Tract Infections in Kidney Transplant Recipients Hospitalized at a Transplantation and Nephrology Ward: 1-Year Follow-up. Transplantation Proceedings. Elsevier; 2016.  Back to cited text no. 13
    
14.
de Souza RM, Olsburgh J. Urinary tract infection in the renal transplant patient. Nat Clin Pract Nephrol 2008;4:252-64.  Back to cited text no. 14
    
15.
Goya N, Tanabe K, Iguchi Y, Oshima T, Yagisawa T, Toma H, et al. Prevalence of urinary tract infection during outpatient follow-up after renal transplantation. Infection 1997;25:101-5.  Back to cited text no. 15
    
16.
Dadhania D, Muthukumar T, Ding R, Li B, Hartono C, Serur D, et al. Molecular signatures of urinary cells distinguish acute rejection of renal allografts from urinary tract infection. Transplantation 2003;75:1752-4.  Back to cited text no. 16
    
17.
John U, Everding AS, Kuwertz-Bröking E, Bulla M, Müller-Wiefel DE, Misselwitz J, et al. High prevalence of febrile urinary tract infections after paediatric renal transplantation. Nephrol Dial Transplant 2006;21:3269-74.  Back to cited text no. 17
    
18.
Lyerová L, Lácha J, Skibová J, Teplan V, Vítko S, Schück O. Urinary tract infection in patients with urological complications after renal transplantation with respect to long-term function and allograft survival. Ann Transplant 2001;6:19-20.  Back to cited text no. 18
    
19.
Ahmed I, Sutton AJ, Riley RD. Assessment of publication bias, selection bias, and unavailable data in meta-analyses using individual participant data: A database survey. BMJ 2012;344:d7762.  Back to cited text no. 19
    
20.
Abeysekera N, Graver A, Cooley L, Kirkland G, Jose MD. Infectious complications in the Southern Tasmanian kidney transplant population. Nephrology (Carlton) 2019;24:849-54.  Back to cited text no. 20
    
21.
Aydın S, Patil A, Desai M, Simforoosh N. Five compelling UTI questions after kidney transplant. World J Urol 2020;38:2733–42.  Back to cited text no. 21
    
22.
Yalci A, Celebi Z, Ozbas B, Sengezer O, Unal H, Memikoğlu K, et al., editors. Evaluation of Infectious Complications in the First Year after Kidney Transplantation. Transplantation proceedings: Elsevier; 2015.  Back to cited text no. 22
    
23.
Shohab D, Khawaja A, Atif E, Jamil I, Ali I, Akhter S. Frequency of occurrence of urinary tract infection in double j stented versus non-stented renal transplant recipients. Saudi J Kidney Dis Transpl 2015;26:443-6.  Back to cited text no. 23
[PUBMED]  [Full text]  
24.
Olenski S, Scuderi C, Choo A, Bhagat Singh AK, Way M, Jeyaseelan L, et al. Urinary tract infections in renal transplant recipients at a quaternary care centre in Australia. BMC Nephrol 2019;20:479.  Back to cited text no. 24
    
25.
Naik AS, Dharnidharka VR, Schnitzler MA, Brennan DC, Segev DL, Axelrod D, et al. Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice. Trans Int 2016;2:241-52.  Back to cited text no. 25
    
26.
Senger S, Arslan H, Azap Ö, Timurkaynak F, Çağır Ü, Haberal M, editors. Urinary Tract Infections in Renal Transplant Recipients. Transplantation Proceedings: Elsevier; 2007.  Back to cited text no. 26
    
27.
Al Midani A, Elands S, Collier S, Harber M, Shendi A, editors. Impact of Urinary Tract Infections in Kidney Transplant Recipients: A 4-Year Single-Center Experience. Transplantation Proceedings: Elsevier; 2018.  Back to cited text no. 27
    
28.
Camargo LF, Esteves AB, Ulisses LR, Rivelli GG, Mazzali M. Urinary tract infection in renal transplant recipients: Incidence, risk factors, and impact on graft function. Transplant Proc 2014;46:1757-9.  Back to cited text no. 28
    
29.
Bodro M, Sanclemente G, Lipperheide I, Allali M, Marco F, Bosch J, et al. Impact of urinary tract infections on short-term kidney graft outcome. Clin Microbiol Inf 2015;12:1104, e1-8.  Back to cited text no. 29
    
30.
Ediriweera DS, Kasturiratne A, Pathmeswaran A, Gunawardena NK, Wijayawickrama BA, Jayamanne SF, et al. Mapping the risk of snakebite in Sri Lanka A national survey with geospatial analysis. PLoS Negl Trop Dis 2016;10:e0004813.  Back to cited text no. 30
    
31.
Wang KJ, Hong WC. Competitive advantage analysis and strategy formulation of airport city development-the case of Taiwan. Trans Policy 2011;1:276-88.  Back to cited text no. 31
    
32.
Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: A retrospective review at two US transplant centers. Clin Transplant 2005;19:230-5.  Back to cited text no. 32
    
33.
Shams SF, Eidgahi ES, Lotfi Z, Khaledi A, Shakeri S, Sheikhi M, et al. Urinary tract infections in kidney transplant recipients 1st year after transplantation. J Res Med Sci 2017;22:20.  Back to cited text no. 33
[PUBMED]  [Full text]  
34.
Papasotiriou M, Savvidaki E, Kalliakmani P, Papachristou E, Marangos M, Fokaefs E, et al. Predisposing factors to the development of urinary tract infections in renal transplant recipients and the impact on the long-term graft function. Ren Fail 2011;33:405-10.  Back to cited text no. 34
    
35.
Origüen J, Fernández-Ruiz M, López-Medrano F, Ruiz-Merlo T, González E, Morales JM, et al. Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: Narrowing of the therapeutic options. Transpl Infect Dis 2016;18:575-84.  Back to cited text no. 35
    
36.
Koch M, Kohnle M, Trapp R, Haastert B, Rump LC, Aker S. Comparable outcome of acute unplanned peritoneal dialysis and haemodialysis. Nephrol Dial Transplant 2012;27:375-80.  Back to cited text no. 36
    
37.
Green H, Rahamimov R, Gafter U, Leibovitci L, Paul M. Antibiotic prophylaxis for urinary tract infections in renal transplant recipients: A systematic review and meta-analysis. Trans Inf Dis 2011;5:441-7.  Back to cited text no. 37
    
38.
Bodro M, Sabé N, Tubau F, Lladó L, Baliellas C, Roca J, et al. Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients. Transplantation 2013;96:843-9.  Back to cited text no. 38
    
39.
Reddy P, Zembower T, Ison M, Baker T, Stosor V. Carbapenem-resistant Acinetobacter baumannii infections after organ transplantation. Trans Inf Dis 2010;1:87-93.  Back to cited text no. 39
    
40.
de Gouvêa EF, Martins IS, Halpern M, Ferreira AL, Basto ST, Gonçalves RT, et al. The influence of carbapenem resistance on mortality in solid organ transplant recipients with Acinetobacter baumannii infection. BMC Infect Dis 2012;12:351.  Back to cited text no. 40
    
41.
Garzoni C, Vergidis P, AST Infectious Diseases Community of Practice. Methicillin-resistant, vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus infections in solid organ transplantation. Am J Transplant 2013;13 Suppl 4:50-8.  Back to cited text no. 41
    
42.
Dromigny JA, Nabeth P, Juergens-Behr A, Perrier-Gros-Claude JD. Risk factors for antibiotic-resistant Escherichia coli isolated from community-acquired urinary tract infections in Dakar, Senegal. J Antimicrob Chemother 2005;56:236-9.  Back to cited text no. 42
    
43.
Randrianirina F, Soares JL, Carod JF, Ratsima E, Thonnier V, Combe P, et al. Antimicrobial resistance among uropathogens that cause community-acquired urinary tract infections in Antananarivo, Madagascar. J Antimicrob Chemother 2007;59:309-12.  Back to cited text no. 43
    
44.
Khosravi AD, Abasi Montazeri E, Ghorbani A, Parhizgari N. Bacterial urinary tract infection in renal transplant recipients and their antibiotic resistance pattern: A four-year study. Iran J Microbiol 2014;6:74-8.  Back to cited text no. 44
    
45.
Samanipour A, Dashti-Khavidaki S, Abbasi MR, Abdollahi A. Antibiotic resistance patterns of microorganisms isolated from nephrology and kidney transplant wards of a referral academic hospital. J Res Pharm Pract 2016;5:43-51.  Back to cited text no. 45
[PUBMED]  [Full text]  
46.
Shirazi M, Ranjbar R, Hemati F, Sadeghifard N. Bacterial infections in renal transplant recipients. Iran J Public Health 2005;3:62-6.  Back to cited text no. 46
    
47.
Mortazavi KM, Koushavar H. Prevalence of Urinary Tract Infections During Outpatient Follow-up after Kidney Transplantation; 2003.  Back to cited text no. 47
    
48.
Pourmand G, Pourmand M, Salem S, Mehrsai A, Taheri Mahmoudi M, Nikoobakht M, et al. Posttransplant infectious complications: A prospective study on 142 kidney allograft recipients. Urol J 2006;3:23-31.  Back to cited text no. 48
    
49.
Zeighami H. Urinary tract infections in renal transplantation patient. Res J Biol Sci 2008;40:1194-6.  Back to cited text no. 49
    
50.
Pourmand M, Keshtvarz M, Talebi M, Mashhadi R. Incidence of Recurrent Urinary Tract Infection after Renal Transplantation. J Med Bacteriol 2015;1-2:27-34.  Back to cited text no. 50
    
51.
Aalimagham M, Pourfarziani V, Hosseini M, Mahfouzi L. Incidence of infections in renal transplant recipients after transplantation. Kowsar Med J 2003;4:309-12.  Back to cited text no. 51
    
52.
Kian Ghanati FF, Hosseini Moghaddam M, Latif Gachkar AK, Adabian S, Sajadini RS. Analysis of genetic determinants involved in antibiotic resistance in clinical strains isolated from urine samples of renal transplantation recipients. Int J Curr Res 2012;4:139-43.  Back to cited text no. 52
    
53.
Mansury D, Khaledi A, Ghazvini K, Sabbagh MG, Zare H, Rokni-Hosseini MH, et al. Study of Bacterial Infections Among Patients Receiving Kidney Transplant in Mashhad, Iran. Exp Clin Transplant 2018;16:282-6.  Back to cited text no. 53
    
54.
Bahrami A, Shams SF, Eidgahi ES, Lotfi Z, Sheikhi M, Shakeri S. Epidemiology of Infectious Complications in Renal Allograft Recipients in the First Year After Transplant. Exp Clin Transplant 2017;15:631-5.  Back to cited text no. 54
    
55.
Sorkhi H, Oliaei F, Rajabpoor MM, Taghavi M. Comparison of urinary tract infection after kidney transplantation between adult and children. Caspian J Pediat 2016;1:96-9.  Back to cited text no. 55
    
56.
Nazemian F, Naghibi M, Farazi E. Kidney transplantation in elderly Iranian patients. Saudi J Kidney Dis Transpl 2007;18:391-6.  Back to cited text no. 56
[PUBMED]  [Full text]  
57.
Fallahzadeh MK, Fallahzadeh MH, Derakhshan A, Basiratnia M, Hoseini Al-Hashemi G, Fallahzadeh MA, et al. Urinary tract infection after kidney transplantation in children and adolescents. Iran J Kidney Dis 2011;5:416-9.  Back to cited text no. 57
    
58.
Pouladfar G, Jafarpour Z, Hosseini SA, Janghorban P, Roozbeh J. Antibiotic selective pressure and development of bacterial resistance detected in bacteriuria following kidney transplantation. Transplant Proc 2015;47:1131-5.  Back to cited text no. 58
    
59.
Ghojogh MG, Salarilak S, Afshari AT, Khalkhali HR, Mohammadi-Fallah MR, Makhdoomi K. The effect of urinary tract infection on patient and graft survival rate in a group of kidney transplanted patients. J Renal Injury Prevent 2018; 4:292-6.  Back to cited text no. 59
    
60.
Esmaeili RA, Mansour N. Comparison of the frequency of bacterial infections before and after kidney transplantation. Lab Med J 2013;5:252-5.  Back to cited text no. 60
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
Previous article  Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusions
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed1590    
    Printed16    
    Emailed0    
    PDF Downloaded308    
    Comments [Add]    

Recommend this journal