Prevalence and Antimicrobial Resistance of Bacterial Uropatho-gens Isolated from Iranian Kidney Transplant Recipients: A Systematic Review and Meta-Analysis
Background: Urinary tract infection (UTI) is a major complication in patients who receive the kidney transplant. We aimed to evaluate the prevalence and antimicrobial resistance of bacterial uropathogens isolated from Iranian kidney transplant recipients.
Methods: We searched according to Prisma protocol for UTI infection, prevalence, occurrence and distribution of bacteria and their pattern of antibiotic resistance among Iranian patients who receive kidney transplant through online electronic databases with MeSh terms and text words in published references in both Persian and English languages during 1990-2017. Data analysis was performed using Comprehensive meta-analysis software (CMA) by Cochrane Q and I2 Random Effects Model.
Results: Eleven studies met the eligible inclusion criteria. The prevalence of UTI among kidney transplant patients varied from 11.7% to 67.5%. The combined prevalence of UTI was 32.6%. Among Gram-negative pathogens causing UTI, E. coli was the most dominant followed by Klebsiella pneumonia with prevalence 41.3% and 11.9%, respectively. Also, amongst Gram-positive bacteria, the highest prevalence belonged to Enterococcus spp. (9.8%) and coagulase-negative Staphylococci (9.4%). Also in Gram-negative pathogens, the most resistance was to ampicillin (91.2%), followed by ceftazidime (89.5%). The minimum resistance was against imipenem with prevalence 14.3%.
Conclusion: The combined prevalence of UTI was 32.6%. Gram-negative pathogens especially E. coli were the most agents of UTI in Iranian patients who receive kidney transplant. Also, in gram-negative pathogens, the most resistance was to ampicillin that it needs a new strategy for prophylaxis and treatment of UTI after the kidney transplant.
2. Wolfe RA, Roys EC, Merion RM (2010). Trends in organ donation and transplantation in the United States, 1999–2008. Am J Transplant, 10:961-972.
3. Ghods AJ (2014). The history of organ donation and transplantation in Iran. Exp Clin Transplant, 12 Suppl 1:38-41.
4. Green M (2013). Introduction: infections in solid organ transplantation. Am J Transplant, 13 Suppl 4:3-8.
5. Fishman JA (2007). Infection in solid-organ transplant recipients. N Engl J Med, 357:2601-2614.
6. Costa SF, Freire MP, Silva LB et al (2012). Evaluation of bacterial infections in organ transplantation. Clinics (Sao Paulo), 67:289-291.
7. Ison M, Grossi P (2013). Donor‐Derived Infections in Solid Organ Transplantation. Am J Transplant, 13 Suppl 4:22-30.
8. Cervera C, Van Delden C, Gavaldà J et al (2014). Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect, 20 Suppl 7:49-73.
9. Van Duin D, Van Delden C (2013). Multidrug‐Resistant Gram‐Negative Bacteria Infections in Solid Organ Transplantation. Am J Transplant, 13 Suppl 4:31-41.
10. Parasuraman R, Julian K (2013). Urinary tract infections in solid organ transplantation. Am J Transplant, 13 Suppl 4:327-36.
11. Graversen ME, Dalgaard LS, Jensen-Fangel S et al (2016). Risk and outcome of pyelonephritis among renal transplant recipients. BMC Infect Dis, 16:264.
12. Valera B, Gentil M, Cabello V et al (2006). Epidemiology of urinary infections in renal transplant recipients. Transplant Proc, 38(8):2414-5.
13. Vidal E, Torre‐Cisneros J, Blanes M et al (2012). Bacterial urinary tract infection after solid organ transplantation in the RESITRA cohort. Transpl Infect Dis, 14:595-603.
14. Samanipour A, Dashti-Khavidaki S, Abbasi M-R, Abdollahi A (2016). Antibiotic resistance patterns of microorganisms isolated from nephrology and kidney transplant wards of a referral academic hospital. J Res Pharm Pract, 5:43-51.
15. Aghazadeh M, Sari S, Nahaie M, Hashemi SSR, Mehri S (2015). Prevalence and antibiotic susceptibility pattern of E. coli isolated from urinary tract infection in patients with renal failure disease and renal transplant recipients. Trop J Pharm Res, 14:649-653.
16. Shams SF, Eidgahi ES, Lotfi Z et al (2017). Urinary tract infections in kidney transplant recipients 1st year after transplantation. J Res Med Sci, 22:20.
17. Momtaz H, Karimian A, Madani M et al (2013). Uropathogenic Escherichia coli in Iran: serogroup distributions, virulence factors and antimicrobial resistance properties. Ann Clin Microbiol Antimicrob, 12:8.
18. Farajzadah AS, Aslani S, Hosseini S et al (2018). Phylotyping based virulence associated genes and drug susceptibility of Uropathogenic Escherichia coli in urinary tract infection patients. J Microbiol Biotechnol, doi: 10.4014/jmb.1801.01031.
19. Raeispour M, Ranjbar R (2018). Antibiotic resistance, virulence factors and genotyping of Uropathogenic Escherichia coli strains. Antimicrob Resist Infect Control, 7:118.
20. Egger M, Smith GD, Schneider M, Minder C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315:629-634.
21. Chiang Y-J, Chen C-H, Wu C-T et al (2004). De novo cancer occurrence after renal transplantation: a medical center experience in Taiwan. Transplant Proc, 36(7):2150-1.
22. Korth J, Kukalla J, Rath P-M et al (2017). Increased resistance of gram-negative urinary pathogens after kidney transplantation. BMC Nephrol, 18:164.
23. Lyerová L, Viklický O, Němcová D, Teplan V (2008). The incidence of infectious diseases after renal transplantation: a single-centre experience. Int J Antimicrob Agents, 31 Suppl 1:S58-62.
24. Säemann M, Hörl W (2008). Urinary tract infection in renal transplant recipients. Eur J Clin Invest, 38 Suppl 2:58-65.
25. Bodro M, Sanclemente G, Lipperheide I et al (2015). Impact of antibiotic resistance on the development of recurrent and relapsing symptomatic urinary tract infection in kidney recipients. Am J Transplant, 15:1021-1027.
26. Rossignol L, Vaux S, Maugat S et al (2017). Incidence of urinary tract infections and antibiotic resistance in the outpatient setting: a cross-sectional study. Infection, 45:33-40.
27. Mansury D, Khaledi A, Ghazvini K et al (2018). Study of Bacterial Infections Among Patients Received Kidney Transplant in Mashhad, Iran. Exp Clin Transplant, 16(3):282-286.
28. Barbouch S, Cherif M, Ounissi M et al (2012). Urinary tract infections following renal transplantation: a single-center experience. Saudi J Kidney Dis Transpl, 23:1311-4.
29. Chuang P, Parikh CR, Langone A (2005). Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant, 19:230-235.
30. Rivera-Sanchez R, Delgado-Ochoa D, Flores-Paz RR et al (2010). Prospective study of urinary tract infection surveillance after kidney transplantation. BMC Infect Dis, 10:245.
31. Esezobor CI, Nourse P, Gajjar P (2012). Urinary tract infection following kidney transplantation: frequency, risk factors and graft function. Pediatr Nephrol, 27:651-657.
32. Acar JF (1997). Consequences of bacterial resistance to antibiotics in medical practice. Clin Infect Dis, 24 Suppl 1:S17-8.
33. Munoz P (2001). Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis, 33 Suppl 1:S53-7.
34. Moysés Neto M, Costa RS, Reis MA, et al (1997). Use of ciprofloxacin as a prophylactic agent in urinary tract infections in renal transplant recipients. Clin Transplant, 11:446-452.
35. Nagler EV, Webster AC, Bolignano D et al (2014). European Renal Best Practice (ERBP) Guideline development methodology: towards the best possible guidelines. Nephrol Dial Transplant, 29:731-738.
36. Toner L, Papa N, Aliyu SH et al (2016). Extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospital urinary tract infections: incidence and antibiotic susceptibility profile over 9 years. World J Urol, 34:1031-1037.
37. Ramadas P, Rajendran PP, Krishnan P et al (2014). Extended-spectrum-beta-lactamase producing bacteria related urinary tract infection in renal transplant recipients and effect on allograft function. PLoS One, 9:e91289.
38. Azap Ö, Togan T, Yesilkaya A et al (2013). Antimicrobial susceptibilities of uropathogen Escherichia coli in renal transplant recipients: dramatic increase in ciprofloxacin resistance. Transplant Proc, 45(3):956-7.
39. Kamath N, John G, Neelakantan N et al (2006). Acute graft pyelonephritis following renal transplantation. Transpl Infect Dis, 8:140-147.
40. Pouladfar G, Jafarpour Z, Hosseini S et al (2015). Antibiotic selective pressure and development of bacterial resistance detected in bacteriuria following kidney transplantation. Transplant Proc, 47(4):1131-5.
41. Khosravi AD, Montazeri EA, Ghorbani A, Parhizgari N (2014). Bacterial urinary tract infection in renal transplant recipients and their antibiotic resistance pattern: A four-year study. Iran J Microbiol, 6:74-78.
42. Shirazi M, Ranjbar R, Hemati F, Sadeghifard N (2005). Bacterial infections in renal transplant recipients. Iran J Public Health, 34:62-66.
43. Pourmand M, Keshtvarz M, Talebi M, Mashhadi R (2015). Incidence of Recurrent Urinary Tract Infection after Renal Transplantation. J Med Bacteriol, 2:27-34.
44. Aalimagham M, Pourfarziani V, Hosseini M, Mahfouzi L (2003). Incidence of infections in renal transplant recipients after transplantation. Kowsar Med J, 7:309-312.
45. Kian Ghanati FF, Mohammad.Hosseini Moghaddam, Latif.Gachkar AK et al (2012). Analysis of genetic determinants involved in antibiotic resistance in clinical strains isolated from urine samples of renal transplantation recipients. Int J Curr Res, 4:139-143.
46. Nazemian F, Naghibi M, Farazi E (2007). Kidney transplantation in elderly Iranian patients. Saudi J Kidney Dis Transpl, 18:391-6.
47. Fallahzadeh MK, Fallahzadeh MH, Derakhshan A, Basiratnia M, Al-Hashemi GH, Fallahzadeh MA, Mahdavi D, Malek-Hosseini SA (2011). Urinary tract infection after kidney transplantation in children and adolescents. Iran J Kidney Dis, 5:416.