Infectious complications remain a major cause of morbidity and mortality among the renal transplant recipients. The prevalence of urinary tract infections (UTIs) after kidney transplantations (KT) reaches 75%. Older age, female gender, and delayed graft function are among the independent risk factors for recurrent UTI in renal transplant recipients. Currently, the mean age of kidney transplant recipients increase is observed including a rise in the number of women in postmenopausal period both in waiting lists and after kidney transplantation. Postmenopausal women with recurrent UTIs after KT especially those caused by multidrug antibiotic resistant (MDR) bacteria form a large and growing up group of patients with almost unachievable remission.
Objective. To develop the efficient treatment schemes for managing recurrent UTIs in postmenopausal female transplant recipients.
Materials and methods. 45 postmenopausal renal transplant recipients with recurrent UTIs were prospectively randomized into 3 groups (15 women in each group) depending on the treatment regimen. Group 1 of recipients received antibiotics according to the urine culture, Group 2 — a fosfomycin course with polyvalent pyobacteriophage followed by furazidine, and Group 3 — comprehensive therapy consisting of a fosfomycin course with polyvalent pyobacteriophage and probiotic supplemented in combination with estrogen treatment delivered vaginally.
Results. Escherichia coli was the responsible pathogen for recurrent UTIs in 55% of cases. Other causative organisms included Klebsiella pneumoniae (35%) as well as Enterobacter spp. (10%). The rate of resistance to all tested antibiotics was the highest in Klebsiella pneumoniae. The first episode of UTI occurred at the 16th [8.5; 42] week after KT. The total number of UTI episodes (per year) after treatment varied from 7 [5; 8] in the reference group to 0 [0; 0] at the treatment group delivered the comprehensive therapy (p<0.001) — 13 of 15 patients achieved a long-term remission during the observation period.
Conclusion. Frequent antibiotic usage often causes MDR as well as results in intestinal dysbacteriosis. Immunosuppression state, frequent antibiotic usage, intestinal dysbiosis and vaginal pH declining in addition form
a pathogenic vicious circle. Complex usage of fosfomycin that remains active against a considerable proportion of MDR gram-negative bacteria with bacteriophages, estrogen treatment and long-term probiotic supplement may reduce the UTI frequency in postmenopausal women after KT.
Автор(ы): A. A. Dolgolikova, M. P. Guberskaya, D. Yu. Efimov, D. N. Sadouski, O. V. Kalachyk