腎移植症例における尿路感染症の検討

Abstract

腎移植57症例中, 術後の細菌尿は50例, UTIは36例で49例は術後4週で発症したが, 半数以上は膿尿を認めず, 症候性の1例がみられたに過ぎない.死体腎移植(CD)群では細菌尿, UTIが有意に多かった.UTI発症の危険因子は術後の細菌尿, CD, HLAミスマッチ数, ステロイド量, 患者, ドナーの年齢等があげられた.術前細菌尿を有する患者23名の中12名は同一菌種の細菌尿を認めている

Clinical significance of urinary tract infections (UTI) after kidney transplantation was studied in 57 cases. Of these patients, the UTI occurred in 63% of cases during follow-up after transplantation. Although the bacteriuria were observed more frequently in living-related donor (LD) group at pre-operation, cadaveric donor (CD) group showed significantly higher frequency in bacteriuria and UTI after transplantation. The initial UTI occurred within 4 weeks after transplantation in 86% of cases. The significant risk factors in the occurrence of UTI were presence of bacteriuria in post-operation, CD group, mismatch numbers in HLA, amount of steroid, and ages of donor and recipient. Of the bacteria isolated, about half were pathogens in UTI, which was a 2 times higher risk compared with the time of chronic hemodialysis. Gram negative rods were found to be major pathogen in UTI cases. The effect of UTI on graft survival was not obvious. However, of the patients who have bacteriuria at operation, 52% were found to have bacteriuria due to the same strain during follow-up. Therefore, bacteriological examination of urine at transplantation must be done carefully.