Impact of Complicated Urinary Tract Infection on Renal Graft Function

Sánchez, Martha Patricia Rodríguez; Rubio, Diana Carolina Afanador; Luna, Isabel Moreno; Padilla, Paola Karina García; Villamizar, Kateir Mariel Contreras; González, Camilo; Trejos, Juan Agustín Patiño

doi:10.1016/j.transproceed.2020.01.066

Cited by 12 publications

(17 citation statements)

References 22 publications

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“…For example, Papasotiriou et al found no association between graft function and UTI [ 12 ]. Other researchers, however, found that the occurrence of complicated UTI has a negative impact on graft function [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Urinary Tract Infections in the First 6 Months after Renal Transplantation

Arabi

Thiab

Altheaby

et al. 2021

International Journal of Nephrology

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Purpose. Urinary tract infections (UTIs) are common in the first 6 months after renal transplantation, and there are only limited data about UTIs after transplantation in Saudi Arabia in general. Methods. A retrospective study from January 2017 to May 2020 with 6-month follow-up. Results. 279 renal transplant recipients were included. Mean age was 43.4 ± 16.0 years, and114 (40.9%) were women. Urinary stents were inserted routinely during transplantation and were removed 35.3 ± 28 days postoperatively. Ninety-seven patients (35%) developed urinary tract infections (UTIs) in the first six months after renal transplantation. Of those who developed the first episode of UTI, the recurrence rates were 57%, 27%, and 14% for having one, two, or three recurrences, respectively. Late urinary stent removals, defined as more than 21 days postoperatively, tended to have more UTIs (OR: 1.43, P: 0.259, CI: 0.76–2.66). Age >40, female gender, history of neurogenic bladder, and transplantation abroad were statistically significant factors associated with UTIs and recurrence. Diabetes, level of immunosuppression, deceased donor renal transplantation, pretransplant residual urine volume, or history of vesicoureteral reflux (VUR) was not associated with a higher incidence of UTIs. UTIs were asymptomatic in 60% but complicated with bacteremia in 6% of the cases. Multidrug resistant organisms (MDROs) were the causative organisms in 42% of cases, and in-hospital treatment was required in about 50% of cases. Norfloxacin + Bactrim DD (160/800 mg) every other day was not associated with the lower risk of developing UTIs compared to the standard prophylaxis daily Bactrim SS (80/400 mg). Conclusion. UTIs and recurrence are common in the first 6 months after renal transplantation. Age >40, female gender, neurogenic bladder, and transplantation abroad are associated with the increased risk of UTIs and recurrence. MDROs are common causative organisms, and hospitalization is frequently required. Dual prophylactic antibiotics did not seem to be advantageous over the standard daily Bactrim.

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Section: Discussionmentioning

confidence: 99%

Urinary Tract Infections in the First 6 Months after Renal Transplantation

Arabi

Thiab

Altheaby

et al. 2021

International Journal of Nephrology

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“…They can lead to sepsis and are a potential threat to life. Aside from progression to septicemia, recent data has suggested a negative impact of even single episodes of (complicated) urinary tract infections on allograft function [ 13 , 15 , 25 , 26 , 27 , 28 ]. In our cohort urinary tract infections were accompanied by significantly worse creatinine clearance both at the end of our study period and one year after KT.…”

Section: Discussionmentioning

confidence: 99%

“…Thus, ASB is commonly screened for and treated in the early posttransplant phase [ 9 ], even though there is ongoing controversy about the impact of ASB and UTI on the overall patient and graft outcome [ 10 , 11 , 12 ]. Several studies have put infections in the context of limited long-term graft function [ 13 , 14 , 15 ]. In transplant recipients the threshold for treatment is commonly set lower due to the increased risk of septicemia or atypical presentation due to immunosuppression.…”

Section: Introductionmentioning

confidence: 99%

Urinary Tract Infections in Kidney Transplant Recipients—Is There a Need for Antibiotic Stewardship?

Strohaeker

Aschke

Koenigsrainer

et al. 2021

JCM

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(1) Background: Urinary tract infections (UTI) are the most common infections after kidney transplantation. Given the risk of urosepsis and the potential threat to the graft, the threshold for treating UTI and asymptomatic bacteriuria with broad spectrum antibiotics is low. Historically fluoroquinolones were prescription favorites for patients that underwent kidney transplantation (KT). After the recent recommendation to avoid them in these patients, however, alternative treatment strategies need to be investigated (2) Methods: We retrospectively analyzed the charts of 207 consecutive adult kidney transplantations that were performed at the department of General, Visceral and Transplantation Surgery of the University Hospital of Tuebingen between January 2015 and August 2020. All charts were screened for the diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infections (UTI) and the patients’ clinical characteristics and outcomes were evaluated. (3) Results: Of the 207 patients, 68 patients suffered from urinary tract infections. Patients who developed UTI had worse graft function at discharge (p = 0.024) and at the 12 months follow-up (p < 0.001). The most commonly prescribed antibiotics were Ciprofloxacin and Piperacillin/Tazobactam. To both, bacterial resistance was more common in the study cohort than in the control group. (4) Conclusions: Urinary tract infections appear to be linked to worse graft functions. Thus, prevention and treatment should be accompanied by antibiotic stewardship teams.

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“…Up to 37% of kidney transplant recipients may suffer from a clinically relevant UTI after surgery [ 101 , 102 ], and these infections are known to cause graft dysfunction and high morbidity and mortality [ 101 , 103 , 104 ]. However, modern studies have not shown these effects in transplant recipient’s patients with AB [ 105 , 106 ].…”

Section: Asymptomatic Bacteriuriamentioning

confidence: 99%