The Role of Host Factors and Bacterial Virulence Genes in the Development of Pyelonephritis Caused by Escherichia Coli in Renal Transplant Recipients

Overview

Journal Clin J Am Soc Nephrol

Specialty Nephrology

Date 2010 May 8

PMID 20448070

Citations 4

Authors

Priscila Reina Siliano

Lillian Andrade Rocha

Jose Osmar Medina-Pestana

Ita Pfeferman Heilberg

Affiliations

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Abstract

Background And Objectives: The aim of this study was to determine the role of host factors and bacterial virulence genes in the development of pyelonephritis caused by Escherichia coli in renal transplant (Tx) recipients.

Design, Setting, Participants, & Measurements: A total of 328 E. coli isolates from cases of cystitis (Cys; n=239) or pyelonephritis (PN; n=89), with 169 from renal Tx recipients, were subjected to molecular analyses to identify P-fimbria subunits (PapC, PapG II, and PapGIII), G- and M-fimbriae, and aerobactin. The presence of antibiotic resistance was also determined. Parameters such as gender, age, immunosuppression regimens, causes of ESRD, kidney donor, intraoperative anastomosis, use of double J stent, trimethoprim/sulfamethoxazole (TMP/SMZ) prophylaxis, and time after Tx were evaluated.

Results: A multivariate analysis showed a significant association between PN and renal Tx. In renal Tx recipients, the risk of occurrence of PN was significantly higher among males and for those no longer receiving TMP/SMZ prophylaxis. E. coli strains isolated from PN presented a lower prevalence of papGIII and lower rates of resistance to pipemidic acid. Although papGII was more prevalent in PN than in Cys, it was not independently associated with PN.

Conclusions: These findings suggested that renal Tx increases the risk for PN, and the male sex represented a host factor independently associated with risk, whereas the prophylaxis with TMP/SMZ was protective. The lack of papGIII and low resistance to first-generation quinolones were bacterial-independent risk factors for PN in Tx.

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References

Lane M, Mobley H . Role of P-fimbrial-mediated adherence in pyelonephritis and persistence of uropathogenic Escherichia coli (UPEC) in the mammalian kidney. Kidney Int. 2007; 72(1):19-25. DOI: 10.1038/sj.ki.5002230. View

Marklund B, Tennent J, Garcia E, Hamers A, Baga M, Lindberg F . Horizontal gene transfer of the Escherichia coli pap and prs pili operons as a mechanism for the development of tissue-specific adhesive properties. Mol Microbiol. 1992; 6(16):2225-42. DOI: 10.1111/j.1365-2958.1992.tb01399.x. View

Johanson I, Plos K, Marklund B, Svanborg C . Pap, papG and prsG DNA sequences in Escherichia coli from the fecal flora and the urinary tract. Microb Pathog. 1993; 15(2):121-9. DOI: 10.1006/mpat.1993.1062. View

Vila J, Simon K, Ruiz J, Horcajada J, Velasco M, Barranco M . Are quinolone-resistant uropathogenic Escherichia coli less virulent?. J Infect Dis. 2002; 186(7):1039-42. DOI: 10.1086/342955. View

GREISEN K, Loeffelholz M, Purohit A, Leong D . PCR primers and probes for the 16S rRNA gene of most species of pathogenic bacteria, including bacteria found in cerebrospinal fluid. J Clin Microbiol. 1994; 32(2):335-51. PMC: 263034. DOI: 10.1128/jcm.32.2.335-351.1994. View

Rice J, Peng T, Kuo Y, Pendyala S, Simmons L, Boughton J . Renal allograft injury is associated with urinary tract infection caused by Escherichia coli bearing adherence factors. Am J Transplant. 2006; 6(10):2375-83. DOI: 10.1111/j.1600-6143.2006.01471.x. View

Kumar A, Verma B, Srivastava A, Bhandari M, Gupta A, Sharma R . Evaluation of the urological complications of living related renal transplantation at a single center during the last 10 years: impact of the Double-J* stent. J Urol. 2000; 164(3 Pt 1):657-60. DOI: 10.1097/00005392-200009010-00010. View

Pelle G, Vimont S, Levy P, Hertig A, Ouali N, Chassin C . Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant. 2007; 7(4):899-907. DOI: 10.1111/j.1600-6143.2006.01700.x. View

Hurst F, Neff R, Falta E, Jindal R, Lentine K, Swanson J . Incidence, predictors, and associated outcomes of prostatism after kidney transplantation. Clin J Am Soc Nephrol. 2009; 4(2):329-36. PMC: 2637579. DOI: 10.2215/CJN.04370808. View

10.

Giral M, Pascuariello G, Karam G, Hourmant M, Cantarovich D, Dantal J . Acute graft pyelonephritis and long-term kidney allograft outcome. Kidney Int. 2002; 61(5):1880-6. DOI: 10.1046/j.1523-1755.2002.00323.x. View

11.

Mabbett A, Ulett G, Watts R, Tree J, Totsika M, Ong C . Virulence properties of asymptomatic bacteriuria Escherichia coli. Int J Med Microbiol. 2008; 299(1):53-63. DOI: 10.1016/j.ijmm.2008.06.003. View

12.

Tseng C, Huang J, Ko W, Yan J, Wu J . Decreased predominance of papG class II allele in Escherichia coli strains isolated from adults with acute pyelonephritis and urinary tract abnormalities. J Urol. 2001; 166(5):1643-6. View

13.

Rodriguez-Siek K, Giddings C, Doetkott C, Johnson T, Fakhr M, Nolan L . Comparison of Escherichia coli isolates implicated in human urinary tract infection and avian colibacillosis. Microbiology (Reading). 2005; 151(Pt 6):2097-2110. DOI: 10.1099/mic.0.27499-0. View

14.

Abbott K, Oliver 3rd J, Hypolite I, Lepler L, Kirk A, Ko C . Hospitalizations for bacterial septicemia after renal transplantation in the united states. Am J Nephrol. 2001; 21(2):120-7. DOI: 10.1159/000046234. View

15.

Velasco M, Horcajada J, Mensa J, Moreno-Martinez A, Vila J, Martinez J . Decreased invasive capacity of quinolone-resistant Escherichia coli in patients with urinary tract infections. Clin Infect Dis. 2001; 33(10):1682-6. DOI: 10.1086/323810. View

16.

Bagel S, Hullen V, Wiedemann B, Heisig P . Impact of gyrA and parC mutations on quinolone resistance, doubling time, and supercoiling degree of Escherichia coli. Antimicrob Agents Chemother. 1999; 43(4):868-75. PMC: 89219. DOI: 10.1128/AAC.43.4.868. View

17.

BAUER A, KIRBY W, SHERRIS J, Turck M . Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol. 1966; 45(4):493-6. View

18.

Ruiz J, Simon K, Horcajada J, Velasco M, Barranco M, Roig G . Differences in virulence factors among clinical isolates of Escherichia coli causing cystitis and pyelonephritis in women and prostatitis in men. J Clin Microbiol. 2002; 40(12):4445-9. PMC: 154654. DOI: 10.1128/JCM.40.12.4445-4449.2002. View

19.

Alangaden G, Thyagarajan R, Gruber S, Morawski K, Garnick J, El-Amm J . Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006; 20(4):401-9. DOI: 10.1111/j.1399-0012.2006.00519.x. View

20.

Fox B, Sollinger H, Belzer F, Maki D . A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora, and the cost-benefit of.... Am J Med. 1990; 89(3):255-74. DOI: 10.1016/0002-9343(90)90337-d. View