High incidence of bacteriuria following renal transplantation in children.
BACKGROUND
Bacteriuria is common post-transplant. However, most studies are in adults with a short follow-up. We have assessed the incidence of bacteriuria, predisposing causes and its effect on short and long-term graft function in children.


METHODS
The notes of 142 children (67% male) who received 168 kidney transplants (138 cadaveric) between 1987 and 1994 were studied. The mean age at transplantation was 9.0 +/- 4.5 years, and 32 children were transplanted pre-emptively. Diagnoses reflected those found in any children's renal failure programme.


RESULTS
Two hundred and thirty one episodes of bacteriuria were detected in 66 patients patients (46%): a rate of one episode per 23 patient months of follow-up. Fifty two percent were during the first year, and 29% of these during the first 4 weeks post-transplant. Forty two children (28%) had recurrences. The incidence was not affected by sex, vesico-ureteric reflux into native kidneys, donor source, circumcision in boys, dialysis pre-transplant or acute rejection. Bacteriuria was significantly more common in patients with a history of bacteriuria before transplant (P < 0.005) and with bladder pathology (P < 0.001). Organisms were predominantly coliforms (41%); 70% were Gram-negative. Sixty percent were resistant to the prescribed antibiotic prophylaxis. There was an associated transient rise in plasma creatinine concentration: mean pre-episode 111 +/- 86 mumol/l vs mean post-episode 134 +/- 108 mumol/l (P < 0.0001). Seventy two percent of episodes were asymptomatic, but even in this group 81% had an associated rise in plasma creatinine (P < 0.001). Despite this, there was no significant decrease in glomerular filtration rate in patients with bacteriuria compared with patients without at the end of follow-up: 50 vs 56 ml/min/1.73 m2 respectively.


CONCLUSIONS
Bacteriuria is common post-transplant, occurring most often in those with bladder pathology or with a history of bacteriuria pre-transplant.
Sharifian
M
M
Great Ormond Street Hospital for Children NHS Trust, London, UK.
Rees
L
L
Trompeter
R S
RS
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001437:Bacteriuria / Q000453:epidemiology* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D004352:Drug Resistance, Microbial / Q000502:physiology; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D016030:Kidney Transplantation; D008297:Male; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies
D000900:Anti-Bacterial Agents; D003404:Creatinine