Bacterial and Viral Infection and Sepsis in Kidney Transplanted Patients

Abstract

Kidney transplanted patients are a unique population with intrinsic susceptibility to viral and bacterial infections, mainly (but not exclusively) due to continuous immunosuppression. In this setting, infectious episodes remain among the most important causes of death, with different risks according to the degree of immunosuppression, time after transplantation, type of infection, and patient conditions. Prevention, early diagnosis, and appropriate therapy are the goals of infective management, taking into account that some specific characteristics of transplanted patients may cause a delay (the absence of fever or inflammatory symptoms, the negativity of serological tests commonly adopted for the general population, or the atypical anatomical presentation depending on the surgical site and graft implantation). This review considers the recent available findings of the most common viral and bacterial infection in kidney transplanted patients and explores risk factors and outcomes in septic evolution.

Relationship between Cytomegalovirus Viremia and Long-Term Outcomes in Kidney Transplant Recipients with Different Donor Ages

“…In transplant patients, similar to other viruses, CMV infection occurs when a significant imbalance between the host immune system and the virus has been established, mainly during the more pronounced immunosuppressive “pressure” in the first period after transplant [ 11 , 12 , 14 ]. The direct correlation between immunosuppressive load and infection was confirmed by the incidence peak of CMV viremia/disease worldwide documented early after transplant (commonly during the first six months) but also in the period immediately after an increase in immunosuppressive treatment or severe immune impairment for different reasons (e.g., treatment of acute rejection, severe contemporary infection, an unintentional increase in drug levels for intestinal problems) [ 4 ].…”

“…With no prevention, almost all recipients with D+/R− combination develop CMV viremia (which, in these cases, indicates a primary infection), and half experience clinical symptoms. The cluster of R− patients represents a niche of high-risk subjects in which CMV infection may also occur after transfusion and sexual activity with CMV-Ig-positive partners [ 4 , 6 , 11 , 12 , 14 ].…”

“…In this context, Cytomegalovirus (CMV), the most common viral infection after kidney transplantation, acquires a central role in its direct progression to CMV clinical syndrome and end-organ disease, but also for its indirect effects, including increased morbidity/mortality, acute and chronic allograft rejection, atherosclerosis, and diabetes [ 2 , 3 , 4 ].…”

Update on the Effect of the Urinary Microbiome on Urolithiasis

“…Because not all urinary tract infection patients develop calcium oxalate stones, it can be understood as a hypothesis, but the microbes in the urine are not entirely essential for forming calcium oxalate stones. Even then, we must consider that the role of the urinary microbiome for stone formation in chronic kidney disease and kidney transplant patients could be more critical due to the perturbation (dysbiosis) of the urinary microbiome induced by immunosuppressive medications and repeated antibiotic treatments [44,45].…”

Böbrek nakli yapılan hastalarda nakil öncesi ve nakil sonrası enfeksiyon etkenlerinin sıklığı

“…Bu dönemde çoğunlukla karşılaşılan enfeksiyon etkenleri arasında CMV, BKV, Pneumocytis, Aspergillus türleri, Nocardia türleri, Listeria spp., Mycobacterium tuberculosis (M. tuberculosis) ve Mycobacterium spp., yer almaktadır. Mella ve arkadaşları böbrek nakli yapılan hastalarda en yaygın olarak viral ve bakteriyel enfeksiyonları ve risk faktörlerini bildirmişlerdir 5 . Geç dönem (üçüncü dönem) olarak adlandırılan altıncı aydan sonraki dönemde ise toplumda yaşayan diğer bireylerde oluşan enfeksiyonlarla benzerlik gösteren enfeksiyonlara rastlanır.…”