Avaliação do uso de cateter vesical impregnado com nitrofurazona como medida preventiva de bacteriúrias assintomáticas e infecções urinárias em transplante renal

• Autor(a) principal: Menezes, Fernando Gatti de [UNIFESP]
• Data de Publicação: 2017
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5194162; http://repositorio.unifesp.br/handle/11600/50706
• topic: Urinary tract infections; Bacteriuria; Kidney transplantation; Disease prevention; Clinical trial; Infecção urinária; Bacteriúria; Transplante renal; Prevenção de doenças; Ensaio clínico

Abstract Objective: To evaluate the efficacy of nitrofurazone-coated silicone urinary catheters in the prevention of asymptomatic bacteriuria and urinary infection among living donor renal transplant recipients, to compare nitrofurantoin resistance and other antibiotics, as well as the impact on function and graft survival. Methods: This is an experimental, prospective, pilot, randomized and controlled, open-label study conducted at the Hospital do Rim (affiliated with the Universidade Federal de São Paulo), comparing clinical and epidemiological characteristics between two groups of patients undergoing bladder catheterization for live donor kidney transplantation: 1) 3-way nitrofural-impregnated silicone urinary catheter; 2) 3-way nonimpregnated silicone urinary catheter. The incidence of asymptomatic bacteriuria, urinary infection and sensitivity profile of the isolated etiological agents in the first month after transplantation were compared between the groups, as well as the evaluation of the impact on graft function during one year. In the comparative analysis of baseline characteristics, we used the Fisher’s exact test to verify homogeneity between dichotomous variables, and the chi-square test with Yate’s correction for categorical variables. Depending on their homogeneity, continuous variables were compared using the t test or Mann-Whitney-Wilcoxon test. We performed Mann-Whitney-Wilcoxon test to evaluate the impact on graft function using mean values of estimated glomerular filtration rate collected at 4 moments: discharge, 30 days, 6 months, and 12 months after transplantation. Results: Between March 2013 and December 2014, 214 patients were randomized, of which 176 ended the study (88 patients in each group). There were no differences between groups regarding clinical and epidemiological characteristics, except for the presence of the double J ureteral catheter (p = 0.04), ureteral catheter (P = 0.02), cardiovascular disease prior to renal transplantation (p = 0.002), mean number of blood transfusions prior to transplantation (p = 0.04) and incidence of discomfort with bladder catheter (p = 0.007), being more frequent in the group that used nitrofurazone-coated silicone urinary catheters. Among the groups of the nitrofural-impregnated silicone urinary catheter and nonimpregnated silicone urinary catheter, the incidence of asymptomatic bacteriuria was: 12.5% VS 11.4%, p = 0.99, respectively, and the incidence of urinary infections was: 8% VS 6.8%, p = 0.99, respectively. Regarding the etiological agents of asymptomatic bacteriuria and urinary infection, 42 strains were isolated with Gram-negative bacteria accounting for 95.24%. Escherichia coli was the most frequent Gram-negative bacteria (47.62%), with the extended spectrum beta-lactamase resistance mechanism (ESBL) present in 21.42% of the isolates, as well as 4.76% of the isolates presented resistance to carbapenems (blaKPC gene). Regarding the comparative analysis of bacterial resistance and impact on graft function in the first 12 months after kidney transplantation, there was no significant difference between the catheter groups. Conclusions: The use of nitrofurazone-coated silicone urinary catheters among living donor renal transplant recipients did not prevent asymptomatic bacteriuria and urinary infection, and increased patients' discomfort significantly, but without impact on the development of antimicrobial resistance, and without impact on graft function during 12 months of follow-up.