Urinary tract infections (UTIs) in kidney transplant patients are a challenge.

To evaluate epidemiology, clinical status, therapeutic management, and clinical outcome of kidney transplant patients in a university hospital for UTI.

We conducted a retrospective observational study, enrolling all kidney transplant patients hospitalized for UTI, with the objective to evaluate the epidemiology, clinical status, therapeutic management, and clinical outcome of kidney transplant patients.

From our real-life experience, infection with multidrug-resistant germs was confirmed as a risk factor for the severe evolution of the infection. At the same time, the re-evaluation of immunosuppressive therapy could be an important therapeutic strategy in the course of infection.

Prompt initiation of empiric antibiotic therapy upon initiation of microbiological investigations may reduce the risk of severe infection progression.

• Urinary tract infections
• Kidney transplant
• Multidrug-resistant germ
• Solid organ transplant recipient
• Empiric therapy

Background and objective

Urinary tract infections (UTI) in kidney transplant recipients can cause significant morbidity and negatively impact both, graft and patient survival. Ureteric stenting in renal transplantation is aimed at reducing the risks of complications like ureteric leak and stenosis. Ureteric stents are not without their potential complications which may include UTI. We aimed to compare urine bacteriology and bacterial colonization of DJ stent following kidney transplantation, and to establish antimicrobial susceptibility to guide the choice of empirical antibiotics in the event of UTI in post-transplant patients with DJ stent.

Materials and methods

This was a prospective study carried out over a year period (February 2020 to January 2021). Eighty post-renal transplant patients with indwelling ureteral stents were recruited for the study. An early morning midstream urine sample was taken for analysis from consenting patients that met the inclusion criteria. All stents were removed via rigid cystoscopy and the distal end of the stent (4cm) was cut off and put in a sterile bottle for microbiological analysis. Sensitivity and resistance were tested against a panel of 19 antibiotics on all microbial isolates. Results were considered statistically significant when p < 0.05.

Results

The mean age of the patients was 47.9+ 12.1 years. Male patients were 60 (75%) while 20 (25%) were females. Fifty-one (52%) patients had hypertension while 25 (26%) had diabetes mellitus. Hypertension and diabetes were noted in 20 (21%) patients while only one patient (1%) had HCV. Prior to renal transplantation, patients had negative urine cultures. The majority of the patients (76, 95%) had their stent retrieved after 4 weeks, 2 (2.5%) of them had stents retrieved after 2 weeks, and 2 (2.5%) had stents retrieved after 8 weeks. There was a significant association between the duration of stent and stent colonization (p=0.031).

No organism was cultured in both the urine and stent in 13 (14.4%) patients. Nine (10%) had positive stent culture with a negative urine culture while 5 (5.6%) had positive urine culture with a negative stent culture. The same organism was noted in both urine and stent in 58 (64.4%) of patients while different organisms were cultured in 5 (5.6%) of the patients. Escherichia coli was the most common organism cultured in the urine of 38 (65.5%) patients and 36 (58.1%) stents, respectively.

The sensitivity pattern shows that the organisms were more susceptible to nitrofurantoin and gentamicin, and resistant to tetracycline and ceftriaxone. Tigecycline showed good susceptibility and poor resistance.

Conclusion

This study shows that stent colonization was slightly higher than urine bacteriology, with both demonstrating similar microbiological patterns. Selection of the initial empiric treatment should be based on local epidemiological data. Initial therapy should be de-escalated to the most narrow-spectrum antibiotics to complete the course of therapy once culture and sensitivity data is available. Antibiotics stewardship will help in reducing the trend of MDR pathogens.

• escherichia coli
• hypertension
• kidney
• transplants

Postmenopausal women and renal transplant recipients are at increased risk of recurrent urinary tract infections (RUTI). Urine and vaginal microbiota of premenopausal controls (N = 18) and RUTI cases (18), and of postmenopausal controls (30) and RUTI cases (20) with and without a renal transplant, were characterized using 16S rRNA sequencing. Participants did not have UTI symptoms at the time of sampling. Gram-negative uropathobionts (predominantly Escherichia/Shigella, Pseudomonas, Klebsiella, and Acinetobacter) had a much higher mean relative abundance in urine than vaginal samples, especially in premenopausal women. No statistically significant differences in mean relative abundances of bacterial groups were found within the premenopausal group or within the postmenopausal group by RUTI or renal transplant status without chronic antibiotic use. Comparing postmenopausal to premenopausal women, mean relative abundances of lactobacilli (especially L. crispatus) in urine and vaginal samples and of Gram-negative uropathobionts in urine were lower, and of BV-anaerobes and Gram-positive uropathobionts in urine and vaginal samples were higher. While RUTI in premenopausal women is predominantly caused by Escherichia, the causative organisms in postmenopausal women are likely more diverse. The relative importance of individual organisms is currently unknown. We recommend that future studies, including intervention studies, include longitudinal microbiota assessments.

• Aged
• Graft Rejection/epidemiology
• Graft Rejection/etiology
• Humans
• Kidney Transplantation/adverse effects
• Medicare
• Risk Factors
• Transplant Recipients
• United States/epidemiology

• T32 AI007291 NIAID NIH HHS
• K23DK115908 NIDDK NIH HHS
• F32DK117563 NIDDK NIH HHS
• F32DK113719 NIDDK NIH HHS
• K01DK101677 NIDDK NIH HHS
• K24DK101828 NIDDK NIH HHS

• Complications of renal transplantation
• Perinephric fluid collection
• Renal parenchymal complications
• Renal transplant
• Urinary obstruction

• Graft Rejection/diagnostic imaging
• Humans
• Kidney Transplantation
• Postoperative Complications/diagnostic imaging
• Risk Factors