tailieunhanh - Chapter 126. Infections in Transplant Recipients (Part 8)

Kidney Transplantation (See Table 126-4) Table 126-4 Common Infections after Kidney Transplantation Period after Transplantation Infection Site Early Month) (6 Urinary tract Bacteria (Escherichia Klebsiella, Enterobacteriaceae, Pseudomonas, Enterococcus) associated bacteremia pyelonephritis; Candida coli, (fever, CMV Bacteria (late bone urinary tract marrow suppression, hepatitis); virus with (nephropathy, and graft infections usually not associated BK bacteremia); virus graft with BK (nephropathy, failure, failure, generalized vasculopathy) vasculopathy) Lungs Bacteria CMV Nocardia; invasive fungi (Legionella in endemic disease; settings) Pneumocystis; Legionella Central nervous system Listeria (meningitis); Toxoplasma gondii CMV disease; Listeria (meningitis); Cryptococcus (meningitis); Nocardia Note: CMV, cytomegalovirus. . | Chapter 126. Infections in Transplant Recipients Part 8 Kidney Transplantation See Table 126-4 Table 126-4 Common Infections after Kidney Transplantation Period after Transplantation Infection Site Early 1 Month Middle 1-4 Months Late 6 Months Urinary tract Bacteria Escherichia coli Klebsiella Enterobacteriaceae Pseudomonas Enterococcus associated with bacteremia and pyelonephritis Candida CMV fever bone marrow suppression hepatitis BK virus nephropathy graft failure vasculopathy Bacteria late urinary tract infections usually not associated with bacteremia BK virus nephropathy graft failure generalized vasculopathy Lungs Bacteria Legionella in endemic settings CMV disease Pneumocystis Legionella Nocardia invasive fungi Central nervous system Listeria meningitis Toxoplasma gondii CMV disease Listeria meningitis Cryptococcus meningitis Nocardia Note CMV cytomegalovirus. Early Infections Bacteria often cause infections that develop in the period immediately after kidney transplantation. There is a role for perioperative antibiotic prophylaxis and many centers give cephalosporins to decrease the risk of postoperative complications. Urinary tract infections developing soon after transplantation are usually related to anatomic alterations resulting from surgery. Such early infections may require prolonged treatment . 6 weeks of antibiotic administration for pyelonephritis . Urinary tract infections that occur 6 months after transplantation may be treated for shorter periods because they do not seem to be associated with the high rate of pyelonephritis or relapse seen with infections that occur in the first 3 months. Prophylaxis with TMP-SMX 1 double-strength tablet 800 mg of sulfamethoxazole 160 mg of trimethoprim per day for the first 4-6 months after transplantation decreases the incidence of early and middle-period infections see below Table 126-4 and Table 126-5