Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis

Abstract

Risk factors and consequences of urinary tract infection (UTI) post-kidney transplant have been variously reported by studies that were heterogenous in immunosuppressants and prophylactic protocols. We aimed to clarify the risks and consequences of UTI in kidney transplant recipients with post-transplantation cotrimoxazole prophylaxis in the context of modern immunosuppression. This retrospective cohort included kidney transplant recipients receiving tacrolimus, mycophenolate, prednisolone, and cotrimoxazole for bacterial UTI prophylaxis. Recipients were categorized into non-UTI and UTI groups. Asymptomatic bacteriuria (ASB) was screened in the first 3 months and was evaluated for association with UTI. Of 348 kidney transplant recipients, 129 were in the UTI group and 219 in the non-UTI group. UTI risk factors were female sex, body mass index ≥ 25 kg/m2, human leukocyte antigen mismatch, and panel reactive antibody ≥ 50%. Recipients with recurrent UTI had inferior allograft function compared with non-UTI recipients. Patient survival was significantly lower in recipients with UTI in the first post-transplant month. Higher degree of immunosuppressions was associated with recurrent UTI and drug-resistant organisms. In conclusion, UTI continues to negatively affect graft function and survival of kidney transplant recipients. Treating ASB in the first 3 months did not reduce the UTI incidence in the first transplantation year.

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

“…Furthermore, it is not clear if UrS increase UTI risk in elder patients more than in the general transplant population. Looking ahead, the future of UTI management in this demographic holds promising prospects since the age itself it not an absolute contraindication for KTX, and the use of new evaluation tools such as Comprehensive geriatric assessment can help select the most suitable patients for KTX [49–51].…”

“… Risk factors for urinary tract infections in kidney transplant recipients [ 23 ▪▪ , 51 ]. IS, immunosuppression; UTI, urinary tract infection.…”

Pathological Approach to Kidney Allograft Infection

“…The dosage of immunosuppression, including anti-rejection treatments, has also been shown to be associated with a post-transplant UTI. Recently, a body mass index (BMI) above 25 kg/m 2 has been identified as another risk for a post-transplant UTI, which could be related to immune dysfunctions caused by excessive adipose tissue and higher weight-based dosages of immunosuppressive medications in these populations [10]. The etiological agents of a UTI following kidney transplantation commonly involve Gram-negative bacteria, including Escherichia coli, Klebsiella spp., Enterococcus spp., Proteus spp., or Pseudomonas aeruginosa.…”

“…It is worth noting that the contemporary use of broad-spectrum antibiotics has led to growing concerns regarding the prevalence of multi-drug resistant (MDR) organisms [18,19]. Moreover, heightened immunosuppression levels, particularly in terms of tacrolimus concentration and corticosteroid dosage, have exhibited a positive correlation with the increased incidence of UTIs caused by MDR organisms [10].…”

“…Microorganisms that can directly infect the kidney allograft pose a significant threat as they can severely damage the transplanted kidney, diminish its function, and curtail the longevity of the allograft [2]. Infections in the kidney allograft can result in the infiltration of inflammatory cells in the interstitium and renal tubular epithelial cells, which can cause allograft dysfunction, leading to irreversible interstitial fibrosis and tubular atrophy [6][7][8][9][10]. This review aims to elucidate the various patterns of interstitial infiltration caused by common post-kidney transplantation infections and offer insights into differentiating them from other conditions that may also cause interstitial inflammation.…”