Risk Factors for Recurrent Urinary Tract Infection in Kidney Transplant Recipients

Lim, Jeong-Hoon; Cho, J.-H.; Lee, J.-H.; Park, Y.-J.; Jin, So-Young; Park, G.-Y.; Kim, J.-S.; Kang, Yoon‐Jung; Kwon, Owen; Choi, Ji-Young; Kim, C.-D.; Kim, Y.-L.; Kim, H.-K.; Huh, Seung; Park, S.-H.

doi:10.1016/j.transproceed.2012.12.011

Cited by 59 publications

(56 citation statements)

References 25 publications

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“…Lim and associates 13 reported that Escherichia coli (64.1%) was the most common pathogen in UTIs, as also reported by our group. They also reported that, in patient groups with recurrent infections, the rate of ESBLpositive Escherichia coli species was significantly higher in their study.…”

Section: Discussionsupporting

confidence: 88%

“…2,7,[11][12][13][14][16][17]19 We also observed that Escherichia coli (22.7%) and Klebsiella pneumoniae (9.2%) were the most common microbial agents. We found a rate of 5.8% for Acinetobacter baumannii, which reportedly shows antibiotic resistance and causes hospital infection outbreaks.…”

Section: Discussionmentioning

confidence: 59%

“…3,7,[11][12][13] Immunosuppressive agents and contamination by outside environmental sources are the 2 major risk factors that reportedly affect UTI rate, especially within the first 6 months after RT. 2,7,14 Studies have reported UTI rates of 35% to 79% after transplant.…”

Section: Discussionmentioning

confidence: 99%

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Yabanoğlu

Alışkan²,

Çalışkan³

et al. 2015

Exp Clin Transplant

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Objectives: This study aimed to compare renal transplant recipients with and without infection with respect to demographic and clinical characteristics as well as risk factors; to determine the incidence of posttransplant infections; and to study the antibiotic resistance patterns of bacterial species identified as the causative organisms in posttransplant infections. Materials and Methods: This study included a total of 136 patients undergoing renal transplant in a 4-year period. The patients were categorized into 2 groups. The 2 groups were compared with each other with respect to general clinical and demographic variables and the number and frequency of infectious attacks within a 1-year follow-up, infection type, and antibiotic resistance patterns. Results: Ninety-two (67.6%) of the subjects were male and 44 (32.4%) were female. A total of 57 (41.9%) patients developed 128 infectious attacks. Urinary tract infections were the most common infections (42.1%). There was a significant correlation between a clinically relevant urinary culture proliferation and postoperative infection rate (P = .002). There was a significant correlation between antimicrobial resistance and the number of infectious attacks (P = .023). There was a significant correlation between the proliferation of Extended Spectrum Beta Lactamase-positive Enterobactericeae species and the number of infectious attacks (P = .000). Conclusions: Presence of a clinically relevant proliferation in the preoperative urinary culture, which was identified as a risk factor for infection, increased the number of infectious attacks. Moreover, Extended Spectrum Beta Lactamasepositive Enterobactericeae species increased the number of infections. These 2 principle results should be taken into account in patient management.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 59%

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Yabanoğlu

Alışkan²,

Çalışkan³

et al. 2015

Exp Clin Transplant

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“…Few published studies focus on the characteristics of patients with repeated episodes of UTI after kidney transplantation, and most of them do include a low number of patients and are featured with a lack of standardized definitions for recurrent UTI (12,13). Furthermore, the relationship between recurrent UTI and drug-resistant strains has not been properly assessed.…”

Section: Introductionmentioning

confidence: 99%

Impact of Antibiotic Resistance on the Development of Recurrent and Relapsing Symptomatic Urinary Tract Infection in Kidney Recipients

Bodro¹,

Sanclemente²,

Lipperheide³

et al. 2015

American Journal of Transplantation

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(abstract #1302).We sought to determine the frequency, risk factors, and clinical impact of recurrent urinary tract infections (UTI) in kidney transplant recipients. Of 867 patients who received a kidney transplant between 2003 and 2010, 174 (20%) presented at least one episode of UTI. Fifty-five patients presented a recurrent UTI (32%) and 78% of them could be also considered relapsing episodes. Recurrent UTI was caused by extended-spectrum betalactamase (ESBL)-producing Klebsiella pneumoniae (31%), followed by non-ESBL producing Escherichia coli (15%), multidrug-resistant (MDR) Pseudomonas aeruginosa (14%), and ESBL-producing E. coli (13%). The variables associated with a higher risk of recurrent UTI were a first or second episode of infection by MDR bacteria (OR 12; 95%CI 528), age >60 years (OR 2.2; 95%CI 1.15.1), and reoperation (OR 3; 95%CI 1.37.1). In addition, more relapses were recorded in patients with UTI caused by MDR organisms than in those with susceptible microorganisms. There were no differences in acute rejection, graft function, graft loss or 1 year mortality between groups. In conclusion, recurrent UTI is frequent among kidney recipients and associated with MDR organism. Classic risk factors for UTI (female gender and diabetes) are absent in kidney recipients, thus highlighting the relevance of uropathogens in this population.

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“…As seen earlier, there was significant reduction in UTIs when two agents (norfloxacin and co-trimoxazole) were used as prophylaxis compared to when only one agent (norfloxacin) was used. Many recent reports have described the use of combinations as prophylaxis, including ciprofloxacin/co-trimoxazole [34][35][36], ceftriaxone/co-trimoxazole [19], and cefotaxime/co-trimoxazole [11]. Co-trimoxazole, which is present in all these combinations, has been considered a routine agent in the antibacterial prophylaxis in RTRs [29].…”

Section: Discussionmentioning

confidence: 99%

Investigation of the effectiveness of antibacterial prophylaxis in renal transplant recipients

Alkatheri

Albekairy

Alharbi

et al. 2014

J Infect Dev Ctries

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Introduction: Bacterial urinary tract infections (UTIs) are very common complications in renal transplant recipients (RTRs). Methodology: This study is a follow-up to a previous investigation of post-renal transplant UTIs, which led to changes in the antibacterial agents used for prophylaxis and its duration. In this retrospective study of the medical records of 86 RTRs, the incidence, risk factors, causative bacteria, and duration prophylaxis were investigated. Results: The average age of the RTRs was 41.55 ± 14.06 years, and two-thirds of them were males. A total of 57.3% of the RTRs received cadaveric kidneys; the rest received kidneys from living related donors. The prescribed regimen (one month or three months of cotrimoxazole and norfloxacin) was completed by 75% of the RTRs. The incidence of UTIs in the RTRs who received this prophylaxis was 32.3%, which was significantly lower than the incidence with norfloxacin alone (56%). Female gender was found to be a risk factor for postrenal transplant UTIs. Escherichia coli was the most common pathogen (51.7%), followed by Klebsiella and Enterobacter (17.2% each). Most UTIs (86.2%) were detected within the first post-transplant month. Conclusions: There was no clear advantage to prescribing antibacterial prophylaxis for three months versus one month, as 86.2% of the UTIs occurred within the first month post-transplant regardless of prophylaxis duration. Using co-trimoxazole/norfloxacin compared to norfloxacin alone did positively affect patient outcome by reducing the incidence of UTIs. This study recommends antimicrobial sensitivity-guided modification of the antibacterial agents used for prophylaxis rather than extension of its duration.

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Risk Factors for Recurrent Urinary Tract Infection in Kidney Transplant Recipients

Cited by 59 publications

References 25 publications

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Impact of Antibiotic Resistance on the Development of Recurrent and Relapsing Symptomatic Urinary Tract Infection in Kidney Recipients

Investigation of the effectiveness of antibacterial prophylaxis in renal transplant recipients

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