scholarly journals The Impact of Timing of Stent Removal on the Incidence of UTI, Recurrence, Symptomatology, Resistance, and Hospitalization in Renal Transplant Recipients

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ziad Arabi ◽  
Khalefa Al Thiab ◽  
Abdulrahman Altheaby ◽  
Mohammed Tawhari ◽  
Ghaleb Aboalsamh ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Group Versus ◽  
Renal Transplant Recipients ◽  
Ureteric Stent ◽  
Stent Removal ◽  
Urological Complications ◽  
Tract Infections ◽  
The Impact ◽  
Removal Group

Purpose. To evaluate the impact of early (<3 weeks) versus late (>3 weeks) urinary stent removal on urinary tract infections (UTIs) post renal transplantation. Methods. A retrospective study was performed including all adult renal transplants who were transplanted between January 2017 and May 2020 with a minimum of 6-month follow-up at King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results. A total of 279 kidney recipients included in the study were stratified into 114 in the early stent removal group (ESR) and 165 in the late stent removal group (LSR). Mean age was 43.4 ± 15.8; women: n: 114, 40.90%; and deceased donor transplant: n: 55, 19.70%. Mean stent removal time was 35.3 ± 28.0 days posttransplant (14.1 ± 4.6 days in the ESR versus 49.9 ± 28.1 days in LSR, p < 0.001 ). Seventy-four UTIs were diagnosed while the stents were in vivo or up to two weeks after the stent removal “UTIs related to the stent” (n = 20, 17.5% in ESR versus n = 54, 32.7% in LSR; p = 0.006 ). By six months after transplantation, there were 97 UTIs (n = 36, 31.6% UTIs in ESR versus n = 61, 37% in LSR; p = 0.373 ). Compared with UTIs diagnosed after stent removal, UTIs diagnosed while the stent was still in vivo tended to be complicated (17.9% versus 4.9%, p : 0.019), recurrent (66.1% versus 46.3%; p : 0.063), associated with bacteremia (10.7% versus 0%; p : 0.019), and requiring hospitalization (61% versus 24%, p : 0.024). Early stent removal decreased the need for expedited stent removal due to UTI reasons (rate of UTIs before stent removal) (n = 11, 9% in the early group versus n = 45, 27% in the late group; p = 0.001 ). The effect on the rate of multidrug-resistant organisms (MDRO) was less clear (33% versus 47%, p : 0.205). Early stent removal was associated with a statistically significant reduction in the incidence of UTIs related to the stent (HR = 0.505, 95% CI: 0.302-0.844, p = 0.009 ) without increasing the incidence of urological complications. Removing the stent before 21 days posttransplantation decreased UTIs related to stent (aOR: 0.403, CI: 0.218-0.744). Removing the stent before 14 days may even further decrease the risk of UTIs (aOR: 0.311, CI: 0.035- 2.726). Conclusion. Early ureteric stent removal defined as less than 21 days post renal transplantation reduced the incidence of UTIs related to stent without increasing the incidence of urological complications. UTIs occurring while the ureteric stent still in vivo were notably associated with bacteremia and hospitalization. A randomized trial will be required to further determine the best timing for stent removal.

scholarly journals The Utility of Routine Ultrasound Imaging after Elective Transplant Ureteric Stent Removal

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Bibek Das ◽  
Dorian Hobday ◽  
Jonathon Olsburgh ◽  
Chris Callaghan
Keyword(s):  
Kidney Transplantation ◽  
Added Value ◽  
Stent Insertion ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Renal Imaging ◽  
Ureteric Stent ◽  
Stent Removal ◽  
Urological Complications ◽  
Repeat Imaging

Background. Ureteric stent insertion during kidney transplantation reduces the incidence of major urological complications (MUCs). We evaluated whether routine poststent removal graft ultrasonography (PSRGU) was useful in detecting MUCs before they became clinically or biochemically apparent.Methods. A retrospective analysis was undertaken of clinical outcomes following elective stent removals from adult single renal transplant recipients (sRTRs) at our centre between 1 January 2011 and 31 December 2013.Results. Elective stent removal was performed for 338 sRTRs. Of these patients, 222 had routine PSRGU (median (IQR) days after stent removal = 18 (11–31)), 79 had urgent PSRGU due to clinical or biochemical indications, 12 had CT imaging, and 25 had no further renal imaging. Of the 222 sRTRs who underwent routine PSRGU, 210 (94.6%) had no change of management, three (1.4%) required repeat imaging only, and eight patients (3.6%) had incidental (nonureteric) findings. One patient (0.5%) had nephrostomy insertion as a result of routine PSRGU findings, but no ureteric stenosis was identified. Of 79 patients having urgent PSRGU after elective stent removal, three patients required transplant ureteric reimplantation.Conclusions. This analysis found no evidence that routine PSRGU at two to three weeks after elective stent removal provides any added value beyond standard clinical and biochemical monitoring.

scholarly journals Timing of Ureteric Stent Removal and Occurrence of Urological Complications after Kidney Transplantation: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 8 (5) ◽  
pp. 689 ◽  
Author(s):  
Isis J. Visser ◽  
Jasper P. T. van der Staaij ◽  
Anand Muthusamy ◽  
Michelle Willicombe ◽  
Jeffrey A. Lafranca ◽  
...  
Keyword(s):  
Systematic Review ◽  
Kidney Transplantation ◽  
Cohort Studies ◽  
Meta Analysis ◽  
Ureteral Stenosis ◽  
Ureteric Stent ◽  
Urinary Leakage ◽  
Stent Removal ◽  
Urological Complications ◽  
Tract Infections

Implanting a ureteric stent during ureteroneocystostomy reduces the risk of leakage and ureteral stenosis after kidney transplantation (KTx), but it may also predispose to urinary tract infections (UTIs). The aim of this study is to determine the optimal timing for ureteric stent removal after KTx. Searches were performed in EMBASE, MEDLINE Ovid, Cochrane CENTRAL, Web of Science, and Google Scholar (until November 2017). For this systematic review, all aspects of the Cochrane Handbook for Interventional Systematic Reviews were followed and it was written based on the PRISMA-statement. Articles discussing JJ-stents (double-J stents) and their time of removal in relation to outcomes, UTIs, urinary leakage, ureteral stenosis or reintervention were included. One-thousand-and-forty-three articles were identified, of which fourteen articles (three randomised controlled trials, nine retrospective cohort studies, and two prospective cohort studies) were included (describing in total n = 3612 patients). Meta-analysis using random effect models showed a significant reduction of UTIs when stents were removed earlier than three weeks (OR 0.49, CI 95%, 0.33 to 0.75, p = 0.0009). Regarding incidence of urinary leakage, there was no significant difference between early (<3 weeks) and late stent removal (>3 weeks) (OR 0.60, CI 95%, 0.29 to 1.23, p = 0.16). Based on our results, earlier stent removal (<3 weeks) was associated with a decreased incidence of UTIs and did not show a higher incidence of urinary leakage compared to later removal (>3 weeks). We recommend that the routine removal of ureteric stents implanted during KTx should be performed around three weeks post-operatively.

scholarly journals Symptomatic Urinary Tract Infections in Renal Transplant Recipients after Cystoscopy for Ureteral Stent Removal

2017 ◽  
Vol 4 (5) ◽  
pp. 405-411 ◽  
Author(s):  
Justin R. Gregg ◽  
Caroline L. Kang ◽  
Thomas R. Talbot ◽  
Derek Moore ◽  
S. Duke Herrell ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Renal Transplant ◽  
Urinary Tract Infections ◽  
Ureteral Stent ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Stent Removal ◽  
Tract Infections

scholarly journals Comparison of a magnetic retrieval device vs. flexible cystoscopy for removal of ureteral stents in renal transplant patients: A randomized controlled trial

2020 ◽  
Vol 15 (2) ◽  
Author(s):  
Anil Kapoor ◽  
Jason Akerman ◽  
Emily Wong ◽  
Gaurav Vasisth ◽  
Fadil Hassan ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Controlled Trial ◽  
Ureteral Stent ◽  
Flexible Cystoscopy ◽  
Stent Removal ◽  
Transplant Patients ◽  
Renal Transplant Patients ◽  
Tract Infections ◽  
Retrieval Device

Introduction: Placement of a ureteral stent at the time of renal transplantation can reduce complications when compared to non-stented anastomoses. Removal by flexible cystoscopy can be associated with discomfort, risk for infection, and high costs. New magnetic stents offer a means of bypassing cystoscopy by use of a magnetic retrieval device. Our objective was to compare clinical and cost-related outcomes of conventional and magnetic stents in patients undergoing deceased donor renal transplantation. Methods: Patients were randomized to receive either a conventional or a Black-Star® magnetic stent. Clinical, procedural, and cost outcomes were assessed, and the Ureteral Stent Symptom Questionnaire (USSQ) was administered with the stent in situ and after stent removal. All variables were compared between groups. Results: Forty-one patients were randomized to conventional (n=19) or Black-Star (n=22) stent. The total time for stent removal under cystoscopy was significantly longer compared to Black-Star removal (6.67±2.47 and 4.80±2.21 minutes, respectively; p=0.019). No differences were found in the USSQ domains between groups. Rates of urinary tract infections and surgical complications between groups were similar. Stent removal was well-tolerated in both groups. Black-Star stent use resulted in a cost savings of $304.02 Canadian dollars (CAD) per case. Conclusions: USSQ scores suggest that stent removal with the Black-Star magnetic stent is as equally well-tolerated as flexible cystoscopy by renal transplant patients. Black-Star stent removal was significantly faster than conventional stents. No differences in discomfort, infection rate, or complication rate were found. Use of the Black-Star stent resulted in an estimated annual savings of $27 360 CAD at our centre.

scholarly journals Urinary Tract Infections in the First 6 Months after Renal Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Ziad Arabi ◽  
Khalefa Al Thiab ◽  
Abdulrahman Altheaby ◽  
Ghaleb Aboalsamh ◽  
Samy Kashkoush ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Urinary Tract ◽  
Neurogenic Bladder ◽  
Urinary Tract Infections ◽  
Female Gender ◽  
Hospital Treatment ◽  
Renal Transplant Recipients ◽  
Increased Risk ◽  
History Of ◽  
Tract Infections

Purpose. Urinary tract infections (UTIs) are common in the first 6 months after renal transplantation, and there are only limited data about UTIs after transplantation in Saudi Arabia in general. Methods. A retrospective study from January 2017 to May 2020 with 6-month follow-up. Results. 279 renal transplant recipients were included. Mean age was 43.4 ± 16.0 years, and114 (40.9%) were women. Urinary stents were inserted routinely during transplantation and were removed 35.3 ± 28 days postoperatively. Ninety-seven patients (35%) developed urinary tract infections (UTIs) in the first six months after renal transplantation. Of those who developed the first episode of UTI, the recurrence rates were 57%, 27%, and 14% for having one, two, or three recurrences, respectively. Late urinary stent removals, defined as more than 21 days postoperatively, tended to have more UTIs (OR: 1.43, P: 0.259, CI: 0.76–2.66). Age >40, female gender, history of neurogenic bladder, and transplantation abroad were statistically significant factors associated with UTIs and recurrence. Diabetes, level of immunosuppression, deceased donor renal transplantation, pretransplant residual urine volume, or history of vesicoureteral reflux (VUR) was not associated with a higher incidence of UTIs. UTIs were asymptomatic in 60% but complicated with bacteremia in 6% of the cases. Multidrug resistant organisms (MDROs) were the causative organisms in 42% of cases, and in-hospital treatment was required in about 50% of cases. Norfloxacin + Bactrim DD (160/800 mg) every other day was not associated with the lower risk of developing UTIs compared to the standard prophylaxis daily Bactrim SS (80/400 mg). Conclusion. UTIs and recurrence are common in the first 6 months after renal transplantation. Age >40, female gender, neurogenic bladder, and transplantation abroad are associated with the increased risk of UTIs and recurrence. MDROs are common causative organisms, and hospitalization is frequently required. Dual prophylactic antibiotics did not seem to be advantageous over the standard daily Bactrim.

scholarly journals 96. Impact of Hospital-Based Pharmacist Discharge Prescription Review on the Appropriateness of Antibiotic Therapy

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S163-S163
Author(s):  
Amy Spigelmyer ◽  
Catessa Howard ◽  
Ilya Rybakov ◽  
Sheena Burwell ◽  
Douglas Slain
Keyword(s):  
Antimicrobial Stewardship ◽  
Group Versus ◽  
Antibiotic Prescribing ◽  
Readmission Rates ◽  
Retrospective Assessment ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Tract Infections ◽  
The Impact ◽  
Discharge Prescription

Abstract Background Inappropriate antibiotic prescribing upon hospital discharge poses an increased risk of excess costs, adverse drug reactions, readmission, and resistance. Despite high rates of antibiotic prescription errors upon discharge, there is no widely accepted antimicrobial stewardship initiative to prevent such errors. This study evaluated the impact of hospital-based clinical pharmacist discharge prescription review on the appropriateness of antibiotic prescriptions. Methods This was a retrospective assessment of patients with discharge antibiotic prescriptions for treatment of pneumonia, urinary tract infections, Clostridioides difficile infections, acute skin and skin structure infections (ABSSSI), or Gram-negative bacteremia between January 2019 and July 2020. The two cohorts that were studied were patients on Hospitalist services versus patients on Medicine services, in which only the Medicine services had rounding pharmacists who perform discharge prescription reviews. Outcomes included demographics, appropriateness of therapy, 30-day readmission rates, and error types in discharge prescriptions. Appropriateness of therapy was validated by evidence-based guidelines and three Infectious Diseases-trained pharmacists. Results Our study included 300 patients, 150 per cohort. Baseline characteristics were similar between groups, with the exception of increased age (p=0.025) and fewer cases of ABSSSI (p=0.001) in the Hospitalist cohort. A statistically significant higher rate of inappropriateness was seen in the Hospitalist group versus Medicine (pharmacist) group, [69/150 (46% versus 25/150 (17%, respectively (p&lt; 0.00001)]. The difference in appropriateness was mainly driven by pneumonia and UTI prescriptions. Thirty day readmission rates were 17% (26/150) for the Hospitalist cohort versus 11% (16/150) in the Medicine (pharmacist) cohort (p=0.134). The most common prescription error was the duration of therapy. Conclusion Appropriateness of antibiotic discharge prescriptions significantly improved in the setting of pharmacist discharge prescription review. This initiative highlights the important role of clinical pharmacists in the setting of outpatient antimicrobial stewardship. Disclosures All Authors: No reported disclosures

scholarly journals Influence ofNAT2Polymorphisms on Sulfamethoxazole Pharmacokinetics in Renal Transplant Recipients

2011 ◽  
Vol 56 (2) ◽  
pp. 825-829 ◽  
Author(s):  
Hideaki Kagaya ◽  
Masatomo Miura ◽  
Takenori Niioka ◽  
Mitsuru Saito ◽  
Kazuyuki Numakura ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Side Effects ◽  
Renal Transplant ◽  
Plasma Concentrations ◽  
Renal Transplant Recipients ◽  
Transplant Recipients ◽  
Slow Acetylator ◽  
Drug Concentrations ◽  
Acetylator Genotype ◽  
The Impact

ABSTRACTThe sulfamethoxazole (SMX)-trimethoprim drug combination is routinely used as prophylaxis againstPneumocystispneumonia during the first 3 to 6 months after renal transplantation. The objective of this study was to examine the impact ofN-acetyltransferase 2 (NAT2) andCYP2C9polymorphisms on the pharmacokinetics of SMX in 118 renal transplant recipients. Starting on day 14 after renal transplantation, patients were administered 400 mg/day-80 mg/day of SMX-trimethoprim orally once daily. On day 14 after the beginning of SMX therapy, plasma SMX concentrations were determined by a high-performance liquid chromatography method. The SMX area under the concentration-time curve from 0 to 24 h (AUC0-24) for 15 recipients with theNAT2slow acetylator genotype (NAT2*5/*6, -*6/*6, -*6/*7, and -*7/*7) was significantly greater than that for 56 recipients with theNAT2rapid acetylator genotype (homozygous forNAT2*4) (766.4 ± 432.3 versus 537.2 ± 257.5 μg-h/ml, respectively;P= 0.0430), whereas there were no significant differences in the SMX AUC0-24between theCYP2C9*1/*1and -*1/*3groups. In a multiple regression analysis, the SMX AUC0-24was associated withNAT2slow acetylator polymorphisms (P= 0.0095) and with creatinine clearance (P= 0.0499). Hepatic dysfunction inNAT2slow acetylator recipient patients during the 6-month period after SMX administration was not observed. SMX plasma concentrations were affected byNAT2polymorphisms and renal dysfunction. Although standard SMX administration to patients withNAT2slow acetylator polymorphisms should be accompanied by monitoring for side effects and drug interaction effects from the inhibition of CYP2C9, SMX administration at a low dose (400 mg) as prophylaxis may not provide drug concentrations that reach the level necessary for the expression of side effects. Further studies with a larger sample size should be able to clarify the relationship between SMX plasma concentration and side effects.

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