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Abstract

Objectives: Urinary tract infection is the most common type of bacterial infection in kidney transplant procedures, with adverse effects on graft and patient survival. We aimed to evaluate the risk factors of recurrent urinary tract infection in renal transplant recipients and its impact on patient and graft survival. Materials and Methods: In a cohort of 1019 patients who were transplanted between 2000 and 2010 at Hamed Al-Essa Organ Transplant Center in Kuwait, 86% developed at least 1 episode of urinary tract infection, with only 6.2% of patients having recurrent infections. We compared patients with recurrent urinary tract infections (group 1) with those who had no recurrence (group 2) regarding their risk factors. Results: Patients in group 1 were significantly younger than those in group 2 (34.9 ± 23 vs 42.8 ± 16 y; P < .001), with female preponderance (P < .001). The percentage of patients with thymoglobulin induction (21.5%) was significantly higher in group 1. Patients with pretransplant urologic problems experienced significantly more recurrent urinary tract infections (P < .001). Hepatitis C infections were significantly more prevalent among group 1 (10.8% vs 3.8%; P = .008). Long-term graft outcome (functioning and failed) were 78.5% and 21.5% in group 1 versus 85.1% and 13.9% in group 2 (P = .18). Patient outcomes (living and deceased donors) were 98.4% and 1.6% in group 1 versus 95.7% and 4.3% in group 2 (P = .187). Conclusions: Adult females, thymoglobulin induction, pretransplant urologic problems, and hepatitis C infection were the risk factors of recurrent urinary tract infection among our renal transplant patients. However, recurrence did not adversely affect graft or patient survival.

Noninvasive Diagnosis of Acute Rejection in Renal Transplant Patients Using Mass Spectrometric Analysis of Urine Samples: A Multicenter Diagnostic Phase III Trial

“…Urinary tract infection was defined by leukocyturia (dipstick positive and/or 5–10 leukocytes/microscopic field in a urinary sediment) in combination with a urine culture with >10 4 bacterial colonies, with or without clinical symptoms. 18 Viral infections (hepatitis B/C, BK virus, and cytomegalovirus) were determined by locally available nucleic acid tests, preformed antibodies by the lymphocytotoxic panel reactive antibody test. Delayed graft function was defined as <500 mL urine within 24 h posttransplantation and/or need of dialysis within the first week (excluding cases with dialysis solely because of hyperkaliemia).…”

Managing recurrent urinary tract infections in kidney transplant recipients using smartphone assisted urinalysis test

“…Another study concluded that combining dipsticks leucocyte and nitrite tests has a sensitivity and specificity of 82% and 84%, respectively (Tawab et al, 2017). A different study from Tanzania reported 56% and 85% sensitivity and specificity, respectively (Katunzi et al, 2019).…”

“…Kidney transplant recipients are particularly vulnerable to UTI due to certain factors that are uniquely associated with transplantation. These include immunosuppressive therapy to prevent rejection, urologic instrumentation including stents, impaired urogenital physiology consequent on surgical alteration of the urogenital system, native kidney diseases such as polycystic kidney disease, reflux nephropathy, nephrolithiasis, and neurogenic bladder (Tawab et al, 2017;Fiorentino et al, 2019). The incidence of recurrent UTI is exceptionally high among kidney transplant recipients and has led to the emergence of multidrugresistant organisms with high hospitalisations costs (Al Midani et al, 2018;Rodríguez Sánchez et al, 2020).…”

“…For these reasons, early diagnosis and prompt treatment are essential to minimise these complications and reduce graft loss (Pesce et al, 2019). Interestingly, only a few studies have assessed the impact of early intervention in reducing UTI complications (Dupont et al, 2007;Tawab et al, 2017).…”

“…On the other hand, the urine dipstick test is a rapid test for UTI diagnosis, but its diagnostic accuracy remains a subject of continuing debate. Several studies have been published that assessed the use of dipstick test and its accuracy as a rapid detector of UTI (Hurlbut & Littenberg, 1991;Mambatta et al, 2015;Tawab et al, 2017). Mambatta argued that urinalysis is better at excluding infections when the test is negative than confirming a UTI when the test is positive.…”