The role of host factors and bacterial virulence genes in the development of pyelonephritis caused by Escherichia coli in renal transplant recipients.
OBJECTIVE
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.


METHODS
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.
Siliano
Priscila Reina
PR
Nephrology Division, Federal University of São Paulo, SP, 04023-900, Brazil.
Rocha
Lillian Andrade
LA
Medina-Pestana
José Osmar
JO
Heilberg
Ita Pfeferman
IP
D018830:Adhesins, Escherichia coli / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D001938:Brazil; D016009:Chi-Square Distribution; D004338:Drug Combinations; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000235:genetics* / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000382:microbiology* / Q000517:prevention & control; D029968:Escherichia coli Proteins / Q000235:genetics; D005260:Female; D036781:Fimbriae Proteins / Q000235:genetics; D006801:Humans; D006877:Hydroxamic Acids / Q000032:analysis; D016030:Kidney Transplantation / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018272:Porins / Q000235:genetics; D011446:Prospective Studies; D011704:Pyelonephritis / Q000382:microbiology* / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013413:Sulfadoxine / Q000627:therapeutic use; D014295:Trimethoprim / Q000627:therapeutic use; D014774:Virulence / Q000235:genetics; D037521:Virulence Factors / Q000235:genetics*; D055815:Young Adult
D018830:Adhesins, Escherichia coli; D000900:Anti-Bacterial Agents; D004338:Drug Combinations; D029968:Escherichia coli Proteins; D006877:Hydroxamic Acids; C519334:PapGII protein, E coli; D018272:Porins; D037521:Virulence Factors; C111243:atpG protein, E coli; D036781:Fimbriae Proteins; C031819:aerobactin; C000301:trimethoprim, sulfadoxine drug combination; D013413:Sulfadoxine; D014295:Trimethoprim
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