Bacterial urinary tract infection after solid organ transplantation in the RESITRA cohort

Abstract

Background Urinary tract infection (UTI) is the most common infection in renal transplant patients, but it is necessary to determine the risk factors for bacterial UTI in recipients of other solid organ transplants (SOTs), as well as changes in etiology, clinical presentation, and prognosis. Methods In total, 4388 SOT recipients were monitored in 16 transplant centers belonging to the Spanish Network for Research on Infection in Transplantation (RESITRA). The frequency and characteristics of bacterial UTI in transplant patients were obtained prospectively from the cohort (September 2003 to February 2005). Results A total of 192 patients (4.4%) presented 249 episodes of bacterial UTI (0.23 episodes per 1000 transplantation days); 156 patients were kidney or kidney–pancreas transplant recipients, and 36 patients were liver, heart, and lung transplant recipients. The highest frequency was observed in renal transplants (7.3%). High frequency of cystitis versus pyelonephritis without related mortality was observed in both groups. The most frequent etiology was Escherichia coli (57.8%), with 25.7% producing extended‐spectrum β‐lactamase (ESBL). In all transplants but renal, most cases occurred in the first month after transplantation. Cases were uniformly distributed during the first 6 months after transplantation in renal recipients. Age (odds ratio [OR] per decade 1.1, 95% confidence interval [CI] 1.02–1.17), female gender (OR 1.74, 95% CI 1.42–2.13), and the need for immediate post‐transplant dialysis (OR 1.63, 95% CI 1.29–2.05) were independent variables associated with bacterial UTI in renal and kidney–pancreas recipients. The independent risk factors identified in non‐renal transplants were age (OR per decade 1.79, 95% CI 1.09–3.48), female gender (OR 1.7, 95% CI 1.43–2.49), and diabetes (OR 1.02, 95% CI 1.001–1.040). Conclusions UTI was frequent in renal transplants, but also not unusual in non‐renal transplants. Because E. coli continues to be the most frequent etiology, the emergence of ESBL‐producing strains has been identified as a new problem. In both populations, most cases were cystitis without related mortality. Although the first month after transplantation was a risk period in all transplants, cases were uniformly distributed during the first 6 months in renal transplants. Age and female gender were identified as risk factors for UTI in both populations. Other particular risk factors were the need for immediate post‐transplant dialysis in renal transplants and diabetes in non‐renal transplants.

Study of the risk factors related to acquisition of urinary tract infections in patients submitted to renal transplant

“…Vidal et al (16) reported E. coli extended spectrum beta-lactamase (ESBL) producers in 26.3% of their samples. In addition, quinolone resistance was identifi ed in 38% of E. coli isolates, 31% of Klebsiella spp.…”

“…In one prospective cohort multicenter study that enrolled 2,052 renal transplant patients, the incidence of UTIs was 10.04%, and the independent risk factors were age, female sex and the need for dialysis post-transplantation (16) . Another report with 393 renal transplanted patients showed a UTI incidence of 56.23%, and the only associated risk factor was age (5) .…”

“…isolates, and 21% of Pseudomonas aeruginosa spp. isolates (16) . Golebiewska et al (24) showed that the most frequently isolated microorganisms were E. coli, E. faecium, Klebsiella spp.…”

The Impact of Infection on Chronic Allograft Dysfunction and Allograft Survival After Solid Organ Transplantation

“…Nevertheless, randomized controlled trials to assess the efficacy of therapy for asymptomatic bacteriuria to improve long-term kidney function are currently lacking. This is particularly relevant, given the widespread emergence of extended-spectrum betalactamase-and carbapenemaseproducing Enterobacteriaceae strains, which have been identified as a major concern in the field of transplant infectious diseases (170,171). In kidney recipients, a risk factor for recurrent UTI after transplantation is the acquisition of MDR pathogens during hospital admission; unfortunately, few antibiotics are available to treat recurrent UTI caused by MDR pathogens (181).…”

“…The main risk factors for UTI are age, female sex, and the need for immediate posttransplant dialysis (171).…”