Incidence and risk factors for urinary tract infections in the first year after renal transplantation

Abstract

Background The most common infections among renal transplant patients are urinary tract infections (UTI). Our main objective in this study is to determine the incidence of UTIs in patients who have undergone renal transplantation in our hospital, to identify the causative microbiological agents, risk factors and determine the effects of UTI on short-term graft survival. Methods Urinary tract infections, which developed within the first year of renal transplantation, were investigated. Patients were compared regarding demographic, clinical, laboratory characteristics and graft survival. Results 102 patients were included in our study. Fifty-three patients (53%) were male and 49 (48%) were female. Sixty-seven urinary tract infection attacks in 21 patients (20.5%) were recorded. Age (p = 0.004; 95% Confidence Interval [CI]: 1.032–1.184), longer indwelling urinary catheter stay time (p = 0.039; 95% Confidence Interval [CI]: 1.013–1.661) and urologic complications (p = 0.006; 95% Confidence Interval [CI]: 0.001–0.320) were found as risk factors for UTI development in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated microorganisms. Of these bacteria, 63.2% were found to be extended spectrum beta lactamase (ESBL) positive. Multidrug resistant microorganisms (MDROs) were more frequent in male patients (32 episodes in males vs. 14 episodes in females, p = <0.001). UTI had no negative impact on short-term graft survival. Conclusion Our study results represent the high incidence of UTI with MDROs in KT recipients. Infection control methods should be applied even more vigorously especially in male transplant patients since a higher incidence of UTI caused by resistant microorganisms was reported in male patients.

Urinary Tract Infection in Kidney Transplant Recipients: The predictors and two-year outcomes

“…In previous studies, it was reported that kidney functions returned to normal over time after an attack of UTI. 14,26 Olenski et al reported that patients with renal dysfunction during an UTI attack were improved their kidney function in the 2nd week after infection, and there was no difference in kidney functions 2 years later when compared to patients who did not develop UTI 4 . In our study, the 2nd year eGFR of patients who were developed UTI was found to be significantly lower when compared to patients who did not develop UTI.…”

“…UTI was accepted as the detection of >105 colony forming units (CFU/mL) of microorganism per urine milliliter and positive urine culture in patients with clinical symptoms of UTI 5,13 . A positive urine culture results detected in patients without clinical symptoms were accepted as asymptomatic bacteriuria (ABU) 5,14 . Recurrent urinary tract infection (R-UTI) was defined as a urinary tract infection that progressed with three or more symptomatic episodes in at least a 12-months period or two or more in any 6-months period 5,14 .…”

“…A positive urine culture results detected in patients without clinical symptoms were accepted as asymptomatic bacteriuria (ABU) 5,14 . Recurrent urinary tract infection (R-UTI) was defined as a urinary tract infection that progressed with three or more symptomatic episodes in at least a 12-months period or two or more in any 6-months period 5,14 . Delayed graft function (DGF) was defined as the need for dialysis within seven days after transplantation 15 .…”

Diabetes Mellitus as a Predictive Factor for Urinary Tract Infection for Patients Treated with Kidney Transplantation

“…For patients with end-stage kidney disease (ESKD) receiving dialysis, kidney transplantation (KT) may have potential benefits in increasing the quality of life and decreasing the risk of mortality [ 1 ]. However, the risk of infection in recipients with KT may be high compared with that in the general public because of the continuous administration of intensive immunosuppressive drugs, and the main cause of mortality and morbidity is contagious bacterial disease [ 2 , 3 ]. Urinary tract infections (UTI) are the most common infectious diseases for KT patients—from 20 to 80% of KT patients develop UTIs [ 4 , 5 ].…”

“…Urinary tract infections (UTI) are the most common infectious diseases for KT patients—from 20 to 80% of KT patients develop UTIs [ 4 , 5 ]. Various risk factors have been distinguished which increase the risk of UTI after KT [ 2 , 6 , 7 , 8 ]. These factors include older age, female sex, diabetes mellitus (DM), history of acute injection, delayed graft function, deceased donor KT, longer duration of dialysis, urological abnormalities, and timing of stent removal [ 2 , 6 , 7 , 8 ].…”