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      Catheter-associated urinary infection in kidney post-transplant patients

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          Abstract

          CONTEXT: There is still controversy as to the use and dosage of antimicrobial prophylaxis of the urinary infection associated with urethral catheterization in the post renal transplant period. OBJECTIVE: To determine whether patients develop urinary infection during short-term urethral catheterization after renal transplant without routine antimicrobial prophylaxis. DESIGN: Prospective study. SETTING: Kidney Transplantation Unit. SAMPLE: 20 patients submitted to non-complicated kidney transplant, with a normal urinary tract and no risk factors present regarding urinary infection. Aged 15 to 65 years. MAIN MEASUREMENTS: Before the transplant, material from the urethral meatus and urine were collected for culture. After the transplant, in the period during which the patient was with short-term urethral catheterization (4 to 5 days), material from the urethral meatus and urine from the bladder and the collecting bag were taken daily from all recipients for culture. RESULTS: There was a predominance of coagulase-negative Staphylococcus and S. viridans in the normal urethral meatus flora and in the first two days of urethral catheterization. After the second day, there was a predominance of E. coli and E. faecalis. Urinary infection did not occur during the period of urethral catheterization. In the follow up only one female patient (7%) had asymptomatic bacteriuria caused by E.coli after the withdrawal of the urethral catheter. CONCLUSIONS: Infection urinary does not occur during the period of urethral catheterization in kidney post-transplant patients. Thus, antimicrobial prophylaxis is not recommended for these patients to prevent urinary infection.

          Translated abstract

          CONTEXTO: Ainda existe controvérsia quanto ao uso e a forma de utilização de profilaxia antimicrobiana da infecção urinária associada ao cateterismo uretral no pós-transplante renal. OBJETIVO: Determinar se os pacientes desenvolvem infecção urinária durante o período de cateterismo uretral de curta duração após o transplante renal, sem usar a profilaxia antimicrobiana de rotina. TIPO DE ESTUDO: Estudo prospectivo. LOCAL: Unidade de Transplante Renal do Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brasil. PACIENTES: 20 pacientes submetidos a transplante renal não-complicado, com trato urinário normal e sem fatores de risco para infecção urinária. Idade variando de 15 a 65 anos de idade. VARIÁVEIS ESTUDADAS: Nos pacientes submetidos a transplante renal, durante o período de cateterismo uretral ( 4 a 5 dias ), urina vesical, urina da bolsa coletora do sistema de drenagem fechado e material do meato uretral, foram coletados diariamente para exame de cultura. RESULTADOS: Houve um predomínio de bactérias Staphylococcus sp coagulase negativa e S. viridans na flora do meato uretral normal e nos primeiros dois dias de cateterismo uretral. Após o segundo dia de cateterismo uretral, houve predomínio de E. coli e E. faecalis. Infecção urinária não ocorreu durante o período de cateterismo uretral. No seguimento, apenas uma paciente (7%) desenvolveu bacteriúria assintomática causada por E. coli após a retirada do cateter uretral. CONCLUSÕES: Não ocorrem infecção urinária durante o período de cateterismo uretral no pós-transplante renal. Portanto, não há necessidade de profilaxia antimicrobiana nesses pacientes para prevenir a infecção urinária.

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          Most cited references32

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          Infectious disease complications of renal transplantation.

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            Infection and cyclosporine.

            Cyclosporine is a potent immunosuppressive agent that selectively impairs T cell function. The steady growth of its importance makes knowledge of its activity and effects clinically relevant. The intrinsic antibiotic activity of cyclosporine is limited; although it inhibits certain viruses, fungi, protozoa, and helminths, in practical terms these effects are insignificant. Both controlled and noncontrolled studies have shown that infection is an infrequent problem in patients with autoimmune diseases who are receiving relatively low doses. The use of cyclosporine in the setting of transplantation does not increase--and may in fact decrease--the incidence of infection in comparison with that during standard immunosuppressive therapy. Fungal, viral, and bacterial diseases remain a risk, however, and are a significant cause of morbidity in this population. Antimicrobial therapy may alter cyclosporine levels and cause nephrotoxicity or graft rejection. Careful monitoring of cyclosporine levels during antimicrobial treatment is therefore recommended.
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              Antimicrobial Prophylaxis for Catheter-Associated Bacteriuria

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                spmj
                Sao Paulo Medical Journal
                Sao Paulo Med. J.
                Associação Paulista de Medicina - APM (São Paulo )
                1806-9460
                September 2001
                : 119
                : 5
                : 165-168
                Affiliations
                [1 ] Universidade de São Paulo Brazil
                [2 ] Universidade de São Paulo Brazil
                Article
                S1516-31802001000500003
                10.1590/S1516-31802001000500003
                11723526
                8606e173-6615-43f4-a55f-4b8cd4e1c435

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=1516-3180&lng=en
                Categories
                MEDICINE, GENERAL & INTERNAL

                Internal medicine
                Urinary infection,Urethral catheterization,Renal Transplantation,Infecção urinária,Cateterismo uretral,Transplante renal

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