摘要:
Objective To investigate the clinical characteristics and the pathogens of recurrent urinary tract infection (RUTI) after renal transplantation.Methods The data of adult recipients with UTI from November 2011 to December 2016 were retrospectively analyzed.The recipients were divided into single UTI (SUTI) group and RUTI group.The clinical characteristics and pathogens were analyzed,and the independent risk factors of RUTI were analyzed using logistic regressionmodel.Results Fifty-three cases were selected,including 29 cases of SUTI and 24 cases of RUTI.The positive rate of blood culture (55% vs.25%,P =0.042) and the concentration of FK506 in the peri-infection period (11.0 + 3.4 ng/mL vs.8.6 + 3.2 ng/mL,P =0.024) in the RUTI group were significantly higher than that those in the SUTI group at the first UTI.The increased concentration of FK506 in the peri-infection period at the first UTI was an independent risk factor for RUTI (β:0.282,95% CI:1.026-1.713,P<0.05).There were 86 infection events in 53 patients,and pathogenic microorganisms were cultured in blood culture and urine culture for 86 times.The positive frequency of culture in the RUTI group was higher than that in the SUTI group,but not significantly.The most common pathogenic microorganisms included Escherichia coli (17 times),pseudomonas aeruginosa (16 times),and Enterococcus (16 times).Conclusion Reduction of the FK506 concentration during the peri-infection period at the first UTI is the key to prevent RUTI after renal transplantation.The empirical antibiotics for RUTI should be sensitive for Escherichia coli (ESBL +)and pseudomonas aeruginosa.%目的 分析肾移植后反复泌尿系统感染(recurrent urinary tract infection,RUTI)的临床特征和病原学特点.方法 回顾性分析2011年11月至2016年12月住院的成人肾移植后泌尿系统感染(urinary tract infection,UTI)的53例受者资料,分为单次泌尿系统感染(single urinary tract infection,SUTI)组29例和RUTI组24例,统计比较两组受者的临床特征和病原学特点.通过Logistic回归分析模型行多因素分析,明确RUTI独立危险因素.结果 RUTI组的首次UTI时血培养阳性率为55%,围感染期血他克莫司浓度为(11.0±3.4)μg/L,均显著高于SUTI组的25%和(8.6±3.2)μg/L(P=0.042,P=0.024).首次UTI围感染期血他克莫司浓度增高(β:0.282,95% CI:1.026~1.713,P<0.05)为RUTI的独立危险因素.53例受者共发生感染事件86次,血培养和尿培养共培养出86次病原微生物.RUTI组的培养阳性率高于SUTI组,但差异无统计学意义.其中最常见的三种病原体为:大肠埃希菌(17次),铜绿假单胞菌(16次)和肠球菌(16次).结论 控制肾移植后首次UTI时围感染期的血他克莫司浓度是防治RUTI的关键;RUTI经验性抗感染治疗选择覆盖绿脓杆菌以及产ESBL肠杆菌科细菌为主的抗生素.