Urinary Tract Infections in Renal Transplant Recipients

Abstract

Renal transplantation (RTx) is the treatment-of-choice for a significant number of patients with end-stage renal disease. Despite recent accomplishments, both surgical and medical complications still exist. Urinary tract infection (UTI) is the most common infectious complication after RTx, while asymptomatic bacteriuria is the most common manifestation of bacteriuria. UTI can impair graft function, potentially reducing graft and patient survival.The aetiology changes with time after RTx. The epidemiology of most of these infections is also changing with resistant organisms being isolated more often than in the past. Several factors increase the risk of infection in RTx patients, and the presence of multiple risk factors in the same patient is not uncommon. These include immunosuppression, urinary flow impairment (most often caused by stenosis or strictures at the vesicoureteral junction, benign prostate hypertrophy or vesicoureteral reflux), and treatment-related factors such as the use of catheters and double-J stents. Early diagnosis and effective treatment are key elements in salvaging both the allograft and the patient. This chapter reviews the definitions, epidemiology, microbiology, screening, clinical manifestations, diagnosis, impact on renal allograft function, evaluation after diagnosis, treatment, prevention including long-term prophylaxis, and the unique challenges of diagnosing and managing recurrent bacterial UTIs in a RTx care setting.

Spectrum Of Urinary Tract Infection Among Renal Allograft Recipients in a Tertiary Care Centre of Northeast India

“…The higher incidence of UTI observed in females (58%) compared to males (42%) is consistent with global trends and can be explained by anatomical and physiological factors that predispose women to UTIs, such as a shorter urethra and its proximity to the anus. [22] This nding aligns with numerous studies that have consistently reported a higher risk of UTIs in females across various populations.…”

Review of Bacterial Urinary Tract Infection in Kidney Transplant Recipients: Incidence, Risk Factors and Impact on the Graft Survival

“…In the RESITRA cohort the distribution of UTI during the first three months of the transplant were 82% cystitis and 18% APN [1]. While other studies, the distribution of UTI during the first 6 years after transplantation were: AB 18.4 and 38%, cystitis 7.6 and 25%, APN 12.5 and 22%, and urosepsis 4% [16,17].…”

“…Although there is no absolute observational statement, Golebiewska [16] suggests that UTI can be a cause and consequence of acute rejection. His group observed that UTI happening just after the transplant deteriorated the renal function from the early time, explaining it by a scarring process which lead to unrecuperate the basal creatinine, even though this event did not increase the mortality or the rejection.…”

“…Risk factors of APN are: female sex, acute rejection, use of mycophenolate as immunosuppressor agent, age, days of bladder catheterization, genitourinary structural or functional abnormalities, UTI the month prior to the transplant, ureteral stent, frequent episodes of acute rejection, cytomegalovirus (CMV) disease, illness of the native kidney, cadaveric donor graft, urological catheter, more than 2 AB episodes, and advanced age of the donor [16,[18][19][20][21][22].…”

“…Reported risk factors of acute cystitis are: female sex, over a week of bladder catheterization, no preoperative prophylactic antibiotic, immunosuppressor induction, recurrent UTI before transplantation, acute rejection, CMV disease, AB, age, haemodialysis just after transplant (reflecting delayed graft function), and BMI of recipient [10,16,18,[22][23][24][25][26].…”