Effects of ureteral stents on risk of bacteriuria in renal allograft recipients.

BACKGROUND: Placement of ureteral stents at the time of renal transplantation is thought to decrease the incidence of postoperative complications, such as anastomotic leakage and stenosis. However, stents may also predispose to post-transplantation urinary tract infection, which can lead to increased risks of graft dysfunction, sepsis, and death. The aim of this study was to analyze the risk of post-transplantation bacteriuria with ureteral stent placement in renal allograft recipients. METHODS: A retrospective single-center analysis was conducted to investigate the incidence of bacteriuria in all renal allograft recipients transplanted between January 2007 and March 2009. Recipients were categorized as in the nonstent group (NSTG) or the stent group (STG). Stent removal was performed per protocol at 6 weeks, and all patients were followed for at least 1 year post transplantation. In the NSTG, the incidence of bacteriuria was assessed at 0-6, 6-12, and 12 weeks to 1 year post transplantation. In the STG, bacteriuria was assessed prior to stent removal, 6 weeks after stent removal, and thereafter until 1 year post transplantation. RESULTS: A total of 395 renal allograft recipients, 183 in the NSTG and 212 in the STG groups, were studied. The overall incidence of bacteriuria within 1 year post transplantation was similar between NSTG and STG (28.0 vs. 24.0%, P = 0.38). No difference was found in the incidence of bacteriuria when NSTG and STG were compared at 0-6 weeks or prior to stent removal (9.7% vs. 9.1%, P = 0.81), at 6-12 weeks, or 6 weeks after stent removal (6.7% vs. 5.8%, P = 0.75), and thereafter for 1 year post transplantation (13.3% vs. 10.8%, P = 0.46). The incidence of graft failure at 1 year was similar in NSTG and STG (6.2% vs. 4.9%, P = 0.6). Urinary anastomotic leakage occurred in none of the NSTG and 2 of the STG recipients. On multivariate analysis, risk factors for bacteriuria were female recipient gender (odds ratio [OR] 2.5, 95% confidence interval [CI] 1.5-4.3, P = 0.001), delayed graft function (DGF) (OR 2.1, 95% CI 1.2-3.8, P = 0.01), and postoperative Foley catheterization for >5 days (OR 4.7, 95% CI 1.3-17.6, P = 0.02). CONCLUSION: Independent risk factors for bacteriuria following kidney transplantation include DGF, prolonged postoperative Foley catheterization, and recipient female gender, but not placement of ureteral stents.

Risk factors for acquiring Strongyloides stercoralis infection among patients attending a tertiary hospital in south India.

PURPOSE: Strongyloides stercoralis causes persistent and fatal disseminated infections in immunocompromised hosts. In this study, we aimed to determine the risk factors for acquiring strongyloidiasis and the associated morbidity in south India. MATERIALS AND METHODS: The study was carried out in two parts. This included a 6-month chart review of cases with strongyloidiasis and randomly selected controls conducted to determine the association with immunocompromised states. Secondly, a cross-sectional study was conducted to investigate hyperinfection in human immunodeficiency virus (HIV)-infected adults where the stool and sputum samples were examined by microscopy for Strongyloides larvae. RESULTS: In the chart review, 118 cases were compared with 240 controls. A higher proportion of patients on corticosteroids [8 (53.3%)] and with HIV infection [3 (60%)] had the risk of acquiring strongyloidiasis than not, although the difference was not statistically significant in this population. In the cross-sectional study, 14/239 HIV-positive individuals had Strongyloides larvae in the stool samples but none had Strongyloides detectable in their sputum samples. The CD4 cell counts were significantly lower in cases with Strongyloides compared with HIV-infected individuals with no parasites in their stool samples (P < 0.001). CONCLUSIONS: In this setting, strongyloidiasis was seen more often in patients on corticosteroid therapy and with HIV infection. In HIV, an association with lower CD4 counts indicates the need for inclusion of Strongyloides as an opportunistic parasite. Gram negative sepsis was an important complication of strongyloidiasis hyperinfection in both HIV and steroid therapy. Further prospective studies on the risk of developing complicated Strongyloides infection are required.

Blinded evaluation of commercial urinary lipoarabinomannan for active tuberculosis: a pilot study.

SETTING: Urine antigen testing is an attractive strategy for the diagnosis of active tuberculosis (TB), but accuracy data are scarce. OBJECTIVE: To prospectively evaluate the diagnostic performance of commercial urinary lipoarabinomannan (LAM) antigen testing for active TB among pulmonary and extra-pulmonary TB suspects. DESIGN: Prospective blinded evaluation of 200 adult TB suspects at a tertiary referral hospital in India. Reference standards included culture and clinical diagnosis. RESULTS: Patients were 61% male (mean age 40.4 years): 8.5% were human immunodeficiency virus (HIV) infected and 47 of 200 (23.5%) were culture-positive for TB. Compared to positivity on either Löwenstein-Jensen (LJ) or BACTEC cultures, LAM sensitivity was 17.8% (95%CI 8.5-32.6), while specificity was 87.7% (95%CI 81.3-92.3). Compared to positivity on both LJ and BACTEC, LAM sensitivity was 5.8% (95%CI 12.5-44.9), with a specificity of 88.8% (95%CI 82.7-92.9). Compared to the clinical diagnosis, LAM sensitivity was 20.0% (95%CI 1.1-70.1), with a specificity of 83.3% (95%CI 50.9-97.0). HIV and smear status did not influence test accuracy. CONCLUSION: In its current form, LAM is insensitive for the diagnosis of active TB, although its specificity is adequate.

Ultrastructural observations in an alcoholic patient with post-surgical pseudomonas infection.

Gram negative bacteria were seen in the peripheral blood and within the neutrophils of a patient with bacteremic shock secondary to Pseudomonas aeruginosa infection. By electron microscopy, bacteria were present either in vacuoles or in the cytoplasm of neutrophils. When seen in the cytoplasm, they were surrounded by amorphous material which most probably represented fused lysosomal granules. In both cases, the microorganisms appeared morphologically normal. The presumption is that there was a pre-existing defect of neutrophilic lysosomal formation or function. These findings indicate the importance of studying neutrophil morphology and function in patients with persistent infections.