Comprehensive Review of Urinary Tract Infections in Renal Transplant Recipients: Clinical Insights and Management Strategies

Bharuka, Vidhi; Meshram, Revat; Munjewar, Pratiksha K

doi:10.7759/cureus.53882

Cited by 2 publications

References 84 publications

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Spectrum Of Urinary Tract Infection Among Renal Allograft Recipients in a Tertiary Care Centre of Northeast India

Sharma,

Qanoongo,

Doley

et al. 2024

Preprint

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Background Urinary tract infection (UTI) poses a significant threat to renal allograft recipients, jeopardizing graft function and patient survival. This study aimed to investigate the incidence, clinical manifestations, microbiological profile, risk factors, and impact of UTI on renal allograft outcomes.Methods A retrospective cohort study was conducted at a tertiary care center in Assam, India, from July 2022 to January 2024, including 220 renal allograft recipients aged over 18 years. Detailed clinical, microbiological, and outcome data were collected and analyzed using SPSS. Multivariate logistic regression was performed to identify independent risk factors.Results The incidence of UTI was 25%, with a higher prevalence in females (58%). Asymptomatic bacteriuria (45%) and cystitis (35%) were the most common UTI types. Escherichia coli (44%) and Klebsiella pneumoniae (32%) were the predominant uropathogens, with 12% of isolates being multi-drug resistant (MDR) and 7% pan-drug resistant (PDR). Female gender (OR 6.73, 95% CI 4.53–12.65, p < 0.001), Prolonged Foley's catheterization (OR 3.92, 95% CI 2.95–4.88, p = 0.019), and Urinary tract abnormalities (OR 2.83, 95% CI 1.61–4.17, p = 0.027) emerged as significant independent risk factors. UTI led to graft failure in 54% of cases, and 3% underwent graft nephrectomy. However, 66% of patients with acute graft dysfunction due to UTI achieved complete recovery with management.Conclusions This study revealed a substantial 25% incidence of urinary tract infection among renal allograft recipients, with the highest risk observed in the early post-transplant period, especially within the first 3 months. Asymptomatic bacteriuria was the most common presentation, and Escherichia coli and Klebsiella pneumoniae were the predominant uropathogens, with a considerable proportion exhibiting multidrug and pan-drug resistance. Female gender, prolonged Foley's catheterization, and urinary tract abnormalities were identified as independent risk factors for UTI development. These findings emphasize the need for heightened vigilance, prompt diagnosis, tailored treatment approaches, and targeted preventive strategies to mitigate the burden of UTIs and combat antimicrobial resistance in this high-risk population.

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Spectrum Of Urinary Tract Infection Among Renal Allograft Recipients in a Tertiary Care Centre of Northeast India

Sharma,

Qanoongo,

Doley

et al. 2024

Preprint

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Microbiological profile and antimicrobial susceptibility of bacteria associated with urinary tract infections in Ukrainian adults

Barannik,

Ishchenko,

Duka

et al. 2024

Med. perspekt.

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The aim of the study was to analyse the microbial profile of the urinary tract infections (UTIs) due to urolithiases and to study susceptibility to antibiotics in its causative agents. The main method of the research was bacteriological. Antimicrobial susceptibility testing was conducted by serial microdilution assay in accordance with recommendations of the European committee on antimicrobial susceptibility testing (EUCAST). For present study 128 unique urine samples were collected from patients with UTIs associated with urolithiasis. Among all collected specimens, 78% (n=100) gave clinically significant growth. Among all examined participants, 88.9% of women (64/72) and 64.3% of men (36/56) had confirmed UTI; in the study, female/male ratio was 1.4 (χ2=9.76; p<0.05). Microorganisms identified in our study predominantly belonged to Bacteria (93.4%), and yeasts of Candida genus comprised only 6.6%. Among all, 66.1% were representatives of Enterobacterales (n=80), particularly, Escherichia coli (38.0%), Klebsiella oxytoca (15.7%), Klebsiella pneumoniae (2.5%), Enterobacter cloacae (5.8%), Proteus mirabilis (4.1%). Isolates of Pseudomonas aeruginosa comprised 3.3%. Among gram-positive isolates, Staphylococcus spp. (14.1%) and Enterococcus spp. (9.9%) were identified. Regarding female/male distribution, the biggest proportion of gram-positive bacteria were isolated from women, statistically significant results were obtained for sex distribution of S. saprophyticus (p<0.05). Antimicrobial susceptibility of Enterobacterales was variable, and the best results were obtained for carbapenems, novel antibiotics (cefiderocol, ceftolozane-tazobactam and ceftazidime-avibactam), aminoglycosides and tigecycline. There were 9 isolates with production of carbapenemases and resistant to all relevant β-lactam antibiotics. All isolated Staphylococcus spp. were β-lactamase producers, one isolate of S. saprophyticus demonstrated methicillin-resistance. To summarise, there is an ongoing outbreak of multidrug-resistant infections in Ukraine and causative agents of UTIs are among the most important contributors. Availability of data on the local antimicrobial susceptibility profile may guide the informed decision making in etiotropic treatment, therefore, contribute to global efforts in rational drug use and fight the resistance escalation.

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Comprehensive Review of Urinary Tract Infections in Renal Transplant Recipients: Clinical Insights and Management Strategies

Cited by 2 publications

References 84 publications

Spectrum Of Urinary Tract Infection Among Renal Allograft Recipients in a Tertiary Care Centre of Northeast India

Spectrum Of Urinary Tract Infection Among Renal Allograft Recipients in a Tertiary Care Centre of Northeast India

Microbiological profile and antimicrobial susceptibility of bacteria associated with urinary tract infections in Ukrainian adults

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