Treatment of recurrent urinary tract infections in a 60-year-old kidney transplant recipient – last-chance antibiotics and phage therapy

Abstract

Background: The article underlines the problem of antimicrobial resistance in transplant departments where wide-spectrum antibiotics must often be used as first line treatment for immunocompromised patients. This applies especially to kidney transplant recipients who suffer from urinary tract infections. Additional means to control infections and support treatment methods are much needed in departments treating transplant patients. Case presentation: This article presents a case of a 60-year-old patient after kidney transplantation repeatedly admitted to the hospital due to recurrent urinary tract infections, including an episode of urosepsis, caused by Klebsiella pneumoniae producing extended-spectrum beta-lactamases (ESBL). Kidney transplantation was performed due to renal insufficiency caused by polycystic kidney disease, without removing of the patient’s own kidneys. As a consequence of numerous episodes of urinary tract infections (12 episodes within 15 months since transplantation), the patient developed chronic infection caused by ESBL-producing K. pneumoniae which showed variable susceptibility to carbapenems and full susceptibility to colistin only. In the meantime, the patient developed accompanying urinary tract infection caused by a vancomycin-resistant Enterococcus faecium and subsequent colonisation of the gastro-intestinal tract by this strain. In an attempt to curb the K. pneumoniae infection, bacteriophage therapy was applied on the experimental basis, coordinated by the Phage Therapy Unit of the Hirszfeld Institute in Wrocław, Poland. Probiotics were also used in an attempt to modify the bacterial gut colonisation. Eventually, the patient fully recovered following nephrectomy of his own left kidney in which cysts were suspected to be the reservoir of bacteria causing recurring infections. In this article we discuss some treatment methods complementary to classic antibiotic therapy, in times when antimicrobial resistance is on the rapid rise. Conclusions: It is necessary to further research methods of decreasing our reliance on antibiotics in view of falling susceptibility to those medicines. Phage therapy or altering patient’s microbiome can give us an edge in tackling infections which today are treated solely with antimicrobials. This would be of great significance to transplant departments.