Mycoplasma and bacteria and risk factors of urinary track infection in long-term follow-up of kidney transplant recipients
10.3760/cma.j.cn114452-20240912-00508
- VernacularTitle:肾移植术后长期患者尿液支原体与细菌分布及危险因素分析
- Author:
Min MIN
1
;
Shanggen LI
;
Weihua YANG
;
Yunheng ZHOU
Author Information
1. 上海市静安区闸北中心医院肾移植康复科，上海200070
- Publication Type:Journal Article
- Keywords:
Kidney transplantation;
Urinary tract infections;
Mycoplasma;
Bacterial pathogens;
Risk factors
- From:
Chinese Journal of Laboratory Medicine
2025;48(3):337-345
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the clinical characteristics, distribution of Mycoplasma and bacteria, and risk factors associated with long-term urinary tract infection (UTI) in patients after kidney transplantation (KT).Methods:A retrospective case-control study was conducted involving a total of 402 inpatients who underwent KT and were suspected of having UTI from January 1, 2023 to July 31, 2024 at Zhabei Central Hospital in the Jing′an District, Shanghai. Pathogen distribution including Mycoplasma and bacteria, was assessed through cultures of midstream urine samples using specialized medium. The patients were categorized into three groups: the bacterial infection group (67 cases), Mycoplasma infection group (56 cases) and non-UTI group (288 cases). Subsequently, the infection group was further divided into sub-groups according to the time after transplantation. Renal function indexes and urine microalbumin (U-mALB) at the time of infections were measured, and the clinical data of inpatients were collected. Risk factors associated with urinary Mycoplasma and bacterial infections were identified using both univariate comparison methods and multivariate logistic regression analysis.Results:Among the 402 KT recipients, 56 patients were found to have Mycoplasma isolated, resulting in an infection rate of 13.9%. Additionally, Ureaplasma spp. Was identified in 11.4% (46/402) patients. About 16.7% (67/402) patients exhibited with bacteria infection, and the most common pathogens were Escherichia coli (27/402, 6.7%), followed by Klebsiella pneumoniae (10/402, 2.5%) and Enterococcus faecalis (10/402, 2.5%). There was significant difference about the infection rate of Mycoplasma among the different periods after transplantation ( P<0.05): 1-<5 years at 26.8%(11/41), 5-<10 years at 15.8%(18/114), 10-<20 years at 11.6%(22/190), above 20 years at 8.8%(5/57). Monofactorial analysis showed that gender (χ 2=8.21, P=0.004), age (χ 2=3.96, P=0.001), post-transplant duration (χ 2=2.83, P=0.005) and U-mALB level (χ 2=3.06, P=0.002) were associated risk factors for Mycoplasma infection ( P<0.05). For bacterial infections, significant associations were found with gender (χ 2=9.41, P=0.003), concomitant diabetes mellitus (χ 2=4.42, P=0.035), blood urea nitrogen (Z=2.68, P=0.007), creatinine (Z=2.81, P=0.005), cystatin C ( Z=3.87, P=0.001), estimated glomerular filtration rate (Z=3.83, P=0.001) and U-mALB level ( Z=3.33, P=0.001). Multivariate logistic regression analysis showed that female ( OR=2.81, 95% CI 1.49-5.31, P=0.001) and younger age( OR=0.95, 95% CI 0.92-0.98, P=0.001) were independent risk factors for Mycoplasma infections ( P<0.05). Female( OR=2.98, 95% CI 1.58-5.64, P=0.001) and concurrent diabetes mellitus ( OR=2.06, 95% CI 1.12-3.76, P=0.019) were the independent risk factors of bacterial infections in KT recipients ( P<0.05). Conclusion:The incidence of Ureaplasma spp. And gram-negative bacteria in UTI is relatively high among patients who have undergone long-term kidney transplantation. Notably, the highest infection rate of Mycoplasma occurs within the first 1 to 5 years post-transplantation. Female and younger age are high-risk factors for Mycoplasma UTIs, while female and concurrent diabetes are the high-risk factors for bacterial UTI.
