Urinary Tract Infections in the First 6 Months after Renal Transplantation

Abstract

Purpose. Urinary tract infections (UTIs) are common in the first 6 months after renal transplantation, and there are only limited data about UTIs after transplantation in Saudi Arabia in general. Methods. A retrospective study from January 2017 to May 2020 with 6-month follow-up. Results. 279 renal transplant recipients were included. Mean age was 43.4 ± 16.0 years, and114 (40.9%) were women. Urinary stents were inserted routinely during transplantation and were removed 35.3 ± 28 days postoperatively. Ninety-seven patients (35%) developed urinary tract infections (UTIs) in the first six months after renal transplantation. Of those who developed the first episode of UTI, the recurrence rates were 57%, 27%, and 14% for having one, two, or three recurrences, respectively. Late urinary stent removals, defined as more than 21 days postoperatively, tended to have more UTIs (OR: 1.43, P: 0.259, CI: 0.76–2.66). Age >40, female gender, history of neurogenic bladder, and transplantation abroad were statistically significant factors associated with UTIs and recurrence. Diabetes, level of immunosuppression, deceased donor renal transplantation, pretransplant residual urine volume, or history of vesicoureteral reflux (VUR) was not associated with a higher incidence of UTIs. UTIs were asymptomatic in 60% but complicated with bacteremia in 6% of the cases. Multidrug resistant organisms (MDROs) were the causative organisms in 42% of cases, and in-hospital treatment was required in about 50% of cases. Norfloxacin + Bactrim DD (160/800 mg) every other day was not associated with the lower risk of developing UTIs compared to the standard prophylaxis daily Bactrim SS (80/400 mg). Conclusion. UTIs and recurrence are common in the first 6 months after renal transplantation. Age >40, female gender, neurogenic bladder, and transplantation abroad are associated with the increased risk of UTIs and recurrence. MDROs are common causative organisms, and hospitalization is frequently required. Dual prophylactic antibiotics did not seem to be advantageous over the standard daily Bactrim.

The Impact of Urinary Tract Infections in Kidney Transplant Recipients: A Six-Year Single-Center Experience

“…Regarding the impact of UTI on graft survival, a previous study conducted among 601 kidney transplant patients revealed that recurrent UTI episodes increased the risk of graft loss by more than 2.5-fold [ 26 ]. In contrast, another study reported that UTI had no negative impact on short-term graft survival, findings that are similar to our own [ 9 ]. These differences could be attributed to variability in study methodology, the target population, or the data collection instruments used.…”

“…However, UTIs and their first recurrence were associated with increased hospitalization rates after transplantation, at 49% and 32% respectively. UTIs were most commonly seen in the first six months post-transplant, and the risk increased with factors such as older age, female gender, neurogenic bladder, and receiving the transplant abroad [ 9 ].…”

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

“…In previous studies, no consistent relationship was found between the induction agent and the development of post-transplant UTI. 1 In our study, although the rate of use of ATG (70%) was high in patients who developed UTI, this was not statistically significant (p=0.33). In other words, in our study, no relationship was found between the induction agent and UTIs after kidney transplantation.…”

“…Surgical procedures, immunosuppressive medicine, dialysis duration, and environmental factors increase the risk of infection in kidney transplant recipients (KTR) compared to the general population. Urinary tract infection (UTI) is the most common infection in KTRs and is especially common in the first year posttransplant in which immunosuppressive treatment is administered more intense 1,2 . UTI is also the leading cause of hospitalization in KTRs 3 .…”

Worldwide prevalence of extended spectrum β-lactamases-producing uropathogenic Escherichia coli isolates among kidney transplant patients: a systematic review and meta-analysis

“…Different risk factors for UTIs following kidney transplant have been found, and they are likely to enhance the incidence of UTIs. These include age, diabetes, female gender, a history of acute renal failure, longer dialysis periods, medical manipulation during transplantation, urological disorders, as well as the immunosuppression level and severity [2][3][4][5]. The most common clinical isolates in UTI patients after Kidney transplantation (KTx) are E. coli isolates, notably the uropathogenic E. coli (UPEC) pathotype [6,7].…”