A J-shaped association between high-sensitivity C-reactive protein and mortality in kidney transplant recipients

Abstract Introduction. Urinary tract infection (UTI) among kidney transplant recipients (KTRs) is one of the most common complications after transplantation. The aim of our study was to analyze the antibiotic sensitivity and resistance of the most common agents causing UTI in Bulgarian KTRs followed up in our Transplant Center. Methods. We analyzed the antibiotic resistance and sensitivity of the most common strains of bacteria causing UTI in the Bulgarian KTRs, namely class Enterobac-teriaceae and Enterococcus spp. We used conventional biochemical methods to identify different strains of uro-pathogens-miniApi (bioMerieux, France) and BBL Crystal (BD). The antibiotic sensitivity was determined via disc-diffusing method, according to the accepted Bulgarian CLSI standard. We used WHONET, version 5.6 to analyze the antibiotic resistance data. Results. The total number of tested patients was 366 [males 228, females 138]. The total number of tested urine samples was 829 [positive ones-203), negative samples 606, contaminated 20]. The most commonly detected uropathogens in Bulgarian KTRs were Gram /-/ negative bacteria (63.80%). Of these, 93.28% belonged to the Enterobacteriaceae group, with E. coli, K. pneumoniae and the PPM /Proteus, Providentia, Mor-ganela/subgroup being the most common (54.5%, 19.20% and 16%, respectively). Gram /+/ positive bacteria were detected in 28.09% of the patients, Enterococcus spp being the most commonly isola-ted-67.79%. In the Enterococcus group, the strains of E. faecalis and E. faecium were the most commonly detected. The bacteria belonging to Enterobacteriaceae group were most sensitive to carbapenems and aminoglycosides, with sensitivity peaking to almost 100%, whereas they were least sensitive to aminopenicillines [sensitivity below 20%]. The PPM subgroup revealed very high sensitivity to beta-lactamase protected broad spectrum penicillins (Piperacillin/Tazobactam, sensitivity - 90%). Gram /+/ positive uropathogens were mostly sensitive to Linezolid, Vancomycin, Teicoplanin (100%). These strains were least sensitive to Erythromycin and Tetracicline (17.50%). Conclusions. Our results were similar to previous studies. The differences detected can be explained with the characteristics of the bacterial strains and the specific practice of each transplant center. Having in mind the possible complications of UTIs, further studies are needed to clarify the problem with antimicrobial resistance in uropathogens and the use of antibiotics after KT.

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An Increase in Myeloid-Related Protein Serum Levels Precedes Acute Renal Allograft Rejection

Journal of the American Society of Nephrology ◽

10.1681/asn.v1291947 ◽

2001 ◽

Vol 12 (9) ◽

pp. 1947-1957

Author(s):

KLAUS BURKHARDT ◽

MARTIN RADESPIEL-TRÖGER ◽

HARALD D. RUPPRECHT ◽

MARGARETE GOPPELT-STRUEBE ◽

REGINE RIESS ◽

...

Keyword(s):

Pilot Study ◽

Renal Transplant ◽

Acute Rejection ◽

High Sensitivity ◽

Serum Levels ◽

Renal Transplant Recipients ◽

Related Protein ◽

Transplant Recipients ◽

C Reactive Protein ◽

Reactive Protein

Abstract. Upon interaction with activated endothelium, monocytes and neutrophils form complexes of myeloid-related protein 8 (MRP8) (S100A8) and MRP14 (S100A9), two members of the calcium-binding S100 family that are secreted during transendothelial migration. In a pilot study of 20 renal transplant recipients and a validation study of 36 renal transplant recipients, MRP8/14 serum levels were measured with an enzyme-linked immunosorbent assay for 28 d, associated with C-reactive protein and creatinine serum levels, and grouped according to biopsy-proven acute rejection. Serum levels of MRP8/14 but not C-reactive protein were significantly increased for several days during the first 2 wk for the acute rejection groups in both studies (P < 0.005, on day 6 after transplantation). As determined by using receiver operating characteristic curves, the optimal cutoff for 100% specificity and high sensitivity (67%) for acute rejection on day 6 after transplantation was calculated to be 4.2 μg/ml for MRP8/14 in the pilot study; this value was confirmed in the validation study. Positive MRP8/14 serum levels preceded acute rejection episodes by a median of 5 d. A 3-d course of intravenous methylprednisolone therapy reduced prerejection MRP8/14 serum levels from 5.7 μg/ml to 3.3 μg/ml (P < 0.05). All MRP8/14 serum levels were below the cutoff during urinary tract infections, delayed graft function, or cytomegalovirus infections, and these values did not differ significantly from control values. It is concluded that the MRP8/14 complex is a very early serum marker suitable for monitoring of acute rejection with high sensitivity and specificity.

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