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siren, Вам хорошо и правильно ответил доктор mkagan, ,добавить практичеки мало что есть.Выложенная выписка адекватная,
выписали вас хорошем состоянии с рекомендациями.Что можно добавить: низкий уровень железа в крови,мне сложно сказать насчет-
лиофилизированный бактериальный лизат- это чисто российское ноу хау , и в мире не известно.Я заглянул в uptodate
-это принятый врачебный ресурс в мире.Я приведу статью оттуда,извините,что на английском,мне просто некогда переводить.Думаю,
что вам помогут перевести.
Urinary tract infection in renal transplant recipients
Author
Mohamed H Sayegh, MD
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Alice M Sheridan, MD
Disclosures
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jan 2012. | This topic last updated: Apr 15, 2009.
OVERVIEW — Urinary tract infection (UTI) is the most common bacterial infection occurring in the renal transplant recipient, particularly in the first few months posttransplant. The major risk factors for UTI in the renal transplant recipient include indwelling bladder catheters, handling and trauma to the kidney and ureter during surgery, anatomic abnormalities of the native or transplanted kidneys (such as vesicoureteral reflux, stones, or stents), neurogenic bladder especially in diabetic patients, and possibly rejection and immunosuppression [1-5]. As an example, as noted in a 2005 Cochrane review, routine intraoperative ureteric stenting is associated with an increased risk of UTI (RR of 1.45, 95% CI 1.04-2.15) [4]. With effective prophylaxis, however, the incidence of UTI has markedly decreased. (See 'Prophylaxis' below.)
The typical microorganisms causing posttransplant UTI are the enteric gram negative bacilli and enterococci. In addition, Corynebacterium urealyticum (group D2) has been recognized as a potential pathogen [6,7]. This observation is clinically important because C. urealyticum is difficult to isolate and is not sensitive to conventional oral antibiotics. Complicated infections are more common among transplant recipients with prolonged anuria as dialysis patients [8].
The management of urinary tract infections, which is not different from those seen in patients who have not been transplanted, is discussed separately. (See "Acute uncomplicated cystitis and pyelonephritis in women" and "Recurrent urinary tract infection in women" and "Urinary tract infection associated with urethral catheters".)
TIMING OF UTI — The morbidity associated with UTI appears to be related to the timing of the episode after transplantation. Infections occurring in the hospital are more serious, with bacteremia occurring in approximately 10 percent and graft infection in 90 percent of recipients. These infections may be associated with allograft dysfunction and may predispose to development of acute rejection.
The clinical presentation of early posttransplantation UTI is variable. Some patients are asymptomatic whereas others present with fever, chills, and graft pain and tenderness. Allograft dysfunction can also occur in this setting.
UTIs developing more than three to six months after transplantation, which are clinically indistinguishable from UTIs in the general population, have traditionally been considered more benign than early UTIs [9-11]. Some evidence, however, suggests that late UTIs are not necessarily benign, being associated with an increased risk of mortality in one large retrospective cohort study [12]. An increased incidence of UTI in men is also associated with benign prostatic hypertrophy, which may increase the risk of allograft loss [13].
An increased number of UTIs over time may also be associated with an enhanced risk of chronic allograft rejection [14,15]. The correlation between UTI and chronic rejection was examined in a study of 255 renal allograft recipients with and 351 patients without evidence of chronic rejection [14]. Beyond the third year after transplantation, patients with increased numbers of UTIs had a significantly enhanced risk of manifesting chronic rejection. They may also produce renal allograft scarring [16]. As a result, UTI should be aggressively diagnosed and treated in the transplant population.
PROPHYLAXIS — We routinely administer trimethoprim-sulfamethoxazole prophylactically, as this regimen has been shown to significantly reduce the incidence of UTI and resultant bacteremia in renal transplant recipients [17,18]. In one study, for example, 132 patients were randomly assigned to receive trimethoprim-sulfamethoxazole or placebo after renal transplantation [18]. Active therapy was associated with a marked reduction in the incidence of urinary tract infection after removal of the bladder catheter in the immediate postoperative period — nine versus 36 in the placebo group. The incidence of other bacterial infections was reduced as well. (See "Differential diagnosis of infection following renal transplantation", section on 'Antimicrobial prophylaxis'.)
The dose of trimethoprim-sulfamethoxazole should be adjusted according to renal function. Patients who are allergic to trimethoprim-sulfamethoxazole can be treated with any of the oral quinolones, such as ciprofloxacin or norfloxacin [1,19].
We usually continue prophylactic therapy for six months to one year in patients with normal urinary tracts [20]. However, indefinite therapy is indicated in patients with a history of recurrent UTIs, anatomic urinary tract abnormalities, or a neurogenic bladder.
И есть еще такая статья,указатель из вышевпреведенной статьи направляет на статью ,которую я приведу ниже,другим сообщением.
Она не касается напрямую людей с пересаженной почкой,но в большинстве своем ,отношение к инфекционному процессу
у людей пересаенных и не пересаженных очень похожее.
Все в руках Всевышнего, кроме страха перед Всевышним
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