Community-acquired pneumonia as a cause of sepsis after renal transplantation
Medical Review (Med. pregled), 2023, 59(2), 33-39.
V. Pencheva1, D. Genov2, O. Georgiev1
1 Clinic of Propedeutics of Internal Diseases, UMHAT Alexandrovska, Medical University – Sofia, Bulgaria
2 Clinic of Nephrology, UMHAT Sv. Ivan Rilski, Medical University – Sofia, Bulgaria
Abstract. Introduction: One of the common complications that may develop in the course of pneumonia in patients after renal transplantation is sepsis. Its appearance worsens prognosis of the outcome, increases the mortality and decreases survival in this group. The aim of the study was to identify factors that can increase the risk for the development of sepsis during the communityacquired pneumonia (CAP) in patients after renal transplantation. Materials and methods: 151 kidney recipients with mean age 41.44 ± 12.03 years were admitted for CAP in Clinic of Pulmonology, UMHAT Alexandrovska, during a 10-year study period. All of them were monitored for the development of sepsis during treatment using different methods of diagnostic. Results: In the course of hospital stays 31 (20.5%) kidney recipients developed sepsis. Pneumonia during the first postoperative month (OR = 10.16; p < 0.0001) or between the 1st and 6th month after surgery (OR = 8.25; p < 0.0001), presence of dyspnea (OR = 4.85; p = 0.0133), bilateral infiltrates (OR = 1.39; p = 0.0172), high levels of C-reactive protein (OR = 1.83; p = 0.0001) and hypoxemia (OR = 2.45; p = 0.0433) of blood-gas analysis during hospitalization were associated with greater probability of developing sepsis. The failure of initial antibiotic therapy (OR = 16.12; p = 0.0001) and the need for mechanical ventilation (OR = 20.83; p < 0.0001) also increased the risk for sepsis in the course of CAP in kidney recipients. Conclusion: Community-acquired pneumonia after renal transplantation is related to a higher risk of developing sepsis. Knowledge of the factors associated with this complication facilitates its early diagnosis and treatment and can support its prevention.
Key words: community-acquired pneumonia, sepsis, renal transplantation, risk factors
Address for correspondence: Assoc. Prof. Ventsislava Pencheva, MD, PhD, e-mail: pencheva.bg@abv.bg