Impact of urinary tract infections on short-term kidney graft outcome

Abstract

Urinary tract infections (UTIs) are frequent after renal transplantation, but their impact on short-term graft outcome is not well established. All kidney transplants performed between July 2003 and December 2010 were investigated to evaluate the impact of UTI on graft function at 1 year after transplantation. Of 867 patients who received a kidney transplant, 184 (21%) developed at least one episode of UTI, at a median of 18 days after transplantation. The prevalence of acute graft pyelonephritis (AGP) was 15%. The most frequent pathogens identified were Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa, 37% of which were considered to be multidrug-resistant strains. Thirty-eight patients (4%) lost their grafts, 225 patients (26%) had graft function impairment and the 1-year mortality rate was 3%; however, no patient died as a consequence of a UTI. Surgical re-intervention and the development of at least one episode of AGP were independently associated with 1-year graft function impairment. Moreover, the development of at least one episode of AGP was associated with graft loss at 1 year. Patients with AGP caused by a resistant strain had graft function impairment more frequently, although this difference did not reach statistical significance (53% vs. 36%, p 0.07). Neither asymptomatic bacteriuria nor acute uncomplicated UTI were associated with graft function impairment in multivariate analysis. To conclude, UTIs are frequent in kidney transplant recipients, especially in the early post-transplantation period. Although AGP was significantly associated with kidney graft function impairment and 1-year post-transplantation graft loss, lower UTIs did not affect graft function.

Risk factors associated with Clostridium difficile infection in kidney transplant recipients

“…We identified antibiotic use for UTI as an independent risk factor for CDI (AOR = 4.17, 95% CI = 1.12‐15.54, P = .034). The UTI indication is not surprising as it is the most common infection post–renal transplant . Unpublished data at our institution over a 5‐year time frame shows that asymptomatic bacteriuria was treated 75% of the time with antibiotics.…”

Epidemiology, risk factors, and impact of bacterial infections on outcomes for pancreatic grafts

“…Several hypotheses may explain the negative impact of infection on graft function, but it is most likely that bacterial infection activates the immune system, thereby inducing acute or chronic rejection and negatively affecting graft function. In kidney recipients, for example, acute graft pyelonephritis has been associated with graft dysfunction and loss . Moreover, when Kamath et al reported that 41% and 28% of patients experienced acute rejection episodes before and after an episode of acute graft pyelonephritis, respectively, they concluded that the process of infection and immune activation can be bidirectional.…”

Systematic review and meta‐analysis of asymptomatic bacteriuria after renal transplantation: incidence, risk of complications, and treatment outcomes

“…Three studies evaluated the incidence of ASB during the first month after KT, finding a pooled incidence of 22% for the first month after KT (Figure S3) with almost no heterogeneity . On the other hand, 10 studies reported data regarding the incidence of ASB during the first year after KT, finding an overall value of 32% (Figure S4) with significantly high heterogeneity (99%) …”

“…Five studies published in the literature have examined the risk of AGR in KT patients with ASB. 4,16,17,20,23 In the meta-analysis, there was no difference between the presence of at least one ASB episode during the first year after KT (n = 551) compared to no ASB episodes during this period (n = 934) regarding the risk for AGR F I G U R E 1 Flowchart diagram of studies selection occurrence (OR 1.09; 95% CI 0.53-2.25), result with a low heterogeneity (I 2 = 48%) ( Figure 2). 16,17,20…”