Author(s): Sundararajaperumal Anandhakrishnan, Murugan Natarajan, Karthick Rajendran, Harikrishnan S

BACKGROUND Renal transplantation is a successful therapy for patients with end-stage kidney disease. In a country like India, where tuberculosis is highly prevalent, it poses immense diagnostic challenge. Proper knowledge about the microbiological spectrum would help to start appropriate therapy empirically, awaiting confirmation. The aim of the study is to study the microbiological profile of lower respiratory tract infections in renal transplant recipients. MATERIALS AND METHODS Consecutive patients who presented to the transplant clinic with cardinal respiratory symptoms and fever were screened radiologically and an attempt to make a microbiological diagnosis was done with sputum or bronchial wash wherever needed. Setting- Prospective observational study conducted in the Department of Nephrology, Transplant Clinic, Rajiv Gandhi Government General Hospital and Madras Medical College. Post-renal transplant patients were followed up for 2 years between October 2014 - October 2016 and the development of pulmonary infection and the number of episodes were systematically recorded. RESULTS A total of 32 episodes of pulmonary infections were observed in 29 patients (23 males and 6 females). Bronchial wash had higher diagnostic yield than sputum. Triple drug immunosuppression comprising cyclosporine, prednisolone and azathioprine (75.8%) and episodes of acute graft rejection requiring pulse methylprednisolone (37.93%) were important prerequisites for developing pulmonary infection. Pseudomonas 12 (3%), Klebsiella 8 (25%) and Mycobacterium tuberculosis 8 (25%) were the most common organisms recovered. CONCLUSION Aggressive diagnostic modalities should be carried out for establishing the diagnosis. Empirical regimens should cover for Pseudomonas and Klebsiella. Tuberculosis should be sought for keenly. Mixed infections were also common in the study.