Skip to main content
SpringerLink
Log in

Harnwegsinfektionen nach Nierentransplantation

Essener Algorithmus zur kalkulierten Antibiotikatherapie

Urinary tract infections after kidney transplantation

Essen algorithm for calculated antibiotic treatment

  • Übersichten
  • Published:
Der Urologe Aims and scope Submit manuscript

Zusammenfassung

Harnwegsinfektionen (HWI) sind die am häufigsten auftretenden Infektionen (besonders in der Frühphase nach Transplantation) und können langfristig die Transplantatfunktion beeinträchtigen. Jeder HWI bei Nierentransplantierten ist mit den entsprechenden Konsequenzen für Diagnose und Therapie als „kompliziert“ anzusehen. Der zunehmende Anteil multiresistenter Keime ist eines der zentralen Probleme bei der Behandlung. Dies bedeutet für den klinischen Alltag u. U. Isolationsmaßnahmen konsequent umzusetzen und die Dauer von eingebrachtem Fremdmaterial (z. B. Blasenverweilkatheter) auf ein Mindestmaß zu reduzieren. Nachweis einer Leukozyturie und Urinkulturen werden benötigt, um die Infektion zu bestätigen, den entsprechenden Keim zu identifizieren und anhand der Urinkultur die antibiotische Therapie zu überprüfen.

Der „Essener Algorithmus zur kalkulierten antibiotischen Behandlung von Harnwegsinfektionen bei nierentransplantierten Patienten“ berücksichtigt neben den gramnegativen Keimen die erhöhte Inzidenz von Enterokokken in der Frühphase nach Transplantation. Innerhalb der ersten beiden Monate sollten Chinolone eingesetzt werden, später Cephalosporine. Bei einer Urosepsis sollten gramnegative Problemkeim (z. B. Pseudomonaden) kalkuliert antibiotisch mitbehandelt werden (z. B. Piperacillin und Tazobactam). Ferner sollte bei schweren Infektionen die kalkulierte Therapie parenteral begonnen werden. In jedem Fall sollten bei der Wahl der kalkulierten Therapie die lokalen Resistenzverhältnisse vertraut sein.

Abstract

Urinary tract infections are the most common infection early after transplantation and can affect long-term graft function. Any urinary tract infection in renal transplant recipients should be seen as “complex” with regard to consequences for diagnosis and therapy. The increase in resistance to anti-infective agents seen among uropathogens is one of the central therapeutic problems. This means for routine clinical practice that contact isolation precautions should be consistently implemented for affected patients and the duration of introducing urinary tract instruments should be minimized. Detection of pyuria and urine cultures are required to confirm infection, to identify the corresponding pathogen, and to review the antibiotic therapy.

The “Essen algorithm for calculated antibiotic treatment of urinary tract infections in renal transplant patients” takes into consideration the high incidence of Gram-negative pathogens in general and the increased incidence of enterococci in the early phase after transplantation. Within the first 2 months after transplantation quinolones should be used and later cephalosporins. In case of urosepsis, calculated antibiotic therapy should cover problematic Gram-negative pathogens such as pseudomonades. The calculated antibiotic therapy should be administered intravenously in severe infections. In any case the local and regional antibiotic susceptibility should be taken into account when deciding on the calculated antibiotic therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Takai K, Tollemar J, Wilczek HE, Groth CG (1998) Urinary tract infections following renal transplantation. Clin Transplant 12(1):19–23

    CAS  PubMed  Google Scholar 

  2. Rabkin DG, Stifelman MD, Birkhoff J et al (1998) Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplant Proc 30(8):4314–4316

    Article  CAS  PubMed  Google Scholar 

  3. Sagalowsky AI, Ransler CW, Peters PC et al (1983) Urologic complications in 505 renal transplants with early catheter removal. J Urol 129(5):929–932

    CAS  PubMed  Google Scholar 

  4. Rice JC, Safdar N (2009) Urinary tract infections in solid organ transplant recipients. Am J Transplant 9(Suppl 4):267–272

    Article  Google Scholar 

  5. Giral M, Pascuariello G, Karam G et al (2002) Acute graft pyelonephritis and long-term kidney allograft outcome. Kidney Int 61(5):1880–1886

    Article  PubMed  Google Scholar 

  6. Witzke O, Schmidt C, Kohnle M et al (2001) Impact of febrile infections on the long-term function of kidney allografts. J Urol 166(6):2048–2052

    Article  CAS  PubMed  Google Scholar 

  7. Abbott KC, Swanson SJ, Richter ER et al (2004) Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis 44(2):353–362

    Article  PubMed  Google Scholar 

  8. Bloom IT, Bentley FR, Garrison RN (1993) Escherichia coli bacteremia exacerbates cyclosporine-induced renal vasoconstriction. J Surg Res 54(5):510–516

    Article  CAS  PubMed  Google Scholar 

  9. Audard V, Amor M, Desvaux D et al (2005) Acute graft pyelonephritis: a potential cause of acute rejection in renal transplant. Transplantation 80(8):1128–1130

    Article  PubMed  Google Scholar 

  10. Muller V, Becker G, Delfs M et al (1998) Do urinary tract infections trigger chronic kidney transplant rejection in man? J Urol 159(6):1826–1829

    Article  CAS  PubMed  Google Scholar 

  11. Mathe Z, Treckmann JW, Heuer M et al (2010) Stented ureterovesical anastomosis in renal transplantation: Does it influence the rate of urinary tract infections? Eur J Med Res 15(7):297–302

    PubMed  Google Scholar 

  12. Barrero R, Fijo J, Fernandez-Hurtado M et al (2007) Vesicoureteral reflux after kidney transplantation in children. Pediatric transplant. 11(5):498–503

    Google Scholar 

  13. Coulthard MG, Keir MJ (2006) Reflux nephropathy in kidney transplants, demonstrated by dimercaptosuccinic acid scanning. Transplantation 82(2):205–210

    Article  CAS  PubMed  Google Scholar 

  14. Mathew TH, Kincaid-Smith P, Vikraman P (1977) Risks of vesicoureteric reflux in the transplanted kidney. N Engl J Med 297(8):414–418

    Article  CAS  PubMed  Google Scholar 

  15. Dupont PJ, Psimenou E, Lord R et al (2007) Late recurrent urinary tract infections may produce renal allograft scarring even in the absence of symptoms or vesicoureteric reflux. Transplantation. 84(3):351–355

    Google Scholar 

  16. Saemann M, Horl WH (2008) Urinary tract infection in renal transplant recipients. Eur J Clin Invest 38(Suppl 2):58–65

    Article  PubMed  Google Scholar 

  17. Rice JC, Peng T, Kuo YF et al (2006) Renal allograft injury is associated with urinary tract infection caused by Escherichia coli bearing adherence factors. Am J Transplant 6(10):2375–2383

    Article  CAS  PubMed  Google Scholar 

  18. Senger SS, Arslan H, Azap OK et al (2007) Urinary tract infections in renal transplant recipients. Transplant Proc 39(4):1016–1017

    Article  CAS  PubMed  Google Scholar 

  19. Pelle G, Vimont S, Levy PP et al (2007) Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 7(4):899–907

    Article  CAS  PubMed  Google Scholar 

  20. Becker S, Feldkamp T, Witzke O et al (2008) Das mikrobiologische Spektrum von schweren, bakteriellen Harnwegsinfekten ändert sich im Verlauf nach Nierentransplantation. Nieren- und Hochdruckkrankheiten 37/9:534

  21. Ramsey DE, Finch WT, Birtch AG (1979) Urinary tract infections in kidney transplant recipients. Arch Surg 114(9):1022–1025

    CAS  PubMed  Google Scholar 

  22. Grabe M, Bishop MC, Bjerklund-Johansen TE et al (2009) Guidelines on Urological Infections. European Association of Urology, Arnhem

  23. Rubin RH, Shapiro ED, Andriole VT et al (1992) Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis 15(Suppl 1):216–227

    Google Scholar 

  24. Hooton TM, Besser R, Foxman B et al (2004) Acute uncomplicated cystitis in an era of increasing antibiotic resistance: a proposed approach to empirical therapy. Clin Infect Dis 39(1):75–80

    Article  PubMed  Google Scholar 

  25. Nicolle LE (2006) Asymptomatic bacteriuria: review and discussion of the IDSA guidelines. Int J Antimicrob Agents 28(Suppl 1):42–48

    Article  Google Scholar 

  26. Reinhart K, Brunkhorst FM, Bone HG et al (2010) Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2 k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V., DSG) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinare Vereinigung fur Intensiv- und Notfallmedizin, DIVI). Ger Med Sci 8

  27. Rubin RH (1993) Infectious disease complications of renal transplantation. Kidney Int 44(1):221–236

    Article  CAS  PubMed  Google Scholar 

  28. Pappas PG, Rex JH, Sobel JD et al (2004) Guidelines for treatment of candidiasis. Clin Infect Dis 38(2):161–189

    Article  PubMed  Google Scholar 

  29. Naber KG, Vahlensieck W, Wagenlehner FME et al (2010) Epidemiologie, Diagnostik, Therapie und Mana- gement unkomplizierter bakterieller ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. S3-Leitlinie AWMF-Register-Nr 043/044 Harnwegsinfektionen

  30. Dantas SR, Kuboyama RH, Mazzali M, Moretti ML (2006) Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect 63(2):117–123

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Forschungsprojektfinanzierung durch Roche Pharma.

Author information

Authors and Affiliations

  1. Klinik für Nephrologie, Zentrum für Innere Medizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    S. Becker, O. Witzke & A. Kribben

  2. Klinik für Urologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Deutschland

    H. Rübben

Authors
  1. S. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. O. Witzke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Rübben
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Kribben
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Becker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Becker, S., Witzke, O., Rübben, H. et al. Harnwegsinfektionen nach Nierentransplantation. Urologe 50, 53–56 (2011). https://doi.org/10.1007/s00120-010-2470-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00120-010-2470-x

Schlüsselwörter

Keywords

Search

Navigation