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

• immunocompromised conditions
• kidney transplantation
• multi-drug resistant Klebsiella pneumoniae
• multidrug-resistant organisms
• urinary tract infection

• extended β-lactam infusion
• immunocompromised condition
• kidney transplantation
• multidrug-resistant Klebsiella pneumoniae
• multidrug-resistant organisms
• urinary tract infection

• MDR
• SOT
• epidemiology
• kidney transplant patients
• management
• risk factors
• urinary tract infections

• Klebsiella pneumoniae
• carbapenem-resistant
• carbapenem-sensitive
• resistance gene
• virulence gene

• Antibiotic resistance genes
• Carbapenem-resistance K. pneumoniae
• Whole genome sequencing

• Humans
• Klebsiella pneumoniae/genetics
• Klebsiella pneumoniae/drug effects
• Klebsiella pneumoniae/isolation & purification
• Klebsiella Infections/microbiology
• Anti-Bacterial Agents/pharmacology
• Multilocus Sequence Typing
• Microbial Sensitivity Tests
• Carbapenems/pharmacology
• Turkey
• beta-Lactamases/genetics
• Drug Resistance, Multiple, Bacterial/genetics
• Carbapenem-Resistant Enterobacteriaceae/genetics
• Carbapenem-Resistant Enterobacteriaceae/drug effects
• Carbapenem-Resistant Enterobacteriaceae/isolation & purification
• Whole Genome Sequencing
• Bacterial Proteins/genetics
• Male
• Genes, Bacterial/genetics

• asymptomatic bacteriuria
• kidney transplantation

• Humans
• Bacteriuria
• Kidney Transplantation/adverse effects
• Anti-Bacterial Agents/therapeutic use
• Urinary Tract Infections/drug therapy
• Transplant Recipients

Urinary tract infections are the most common complication in kidney transplant recipients, possibly resulting in the deterioration of a long-term kidney allograft function and an increased risk of recipient’s death. K. pneumoniae has emerged as one of the most prevalent etiologic agents in the context of recurrent urinary tract infections, especially with multidrug resistant strains. This paper discusses the epidemiology and risk factors associated with urinary tract infections in kidney transplant recipients, multi-drug resistance of K. pneumoniae (ESBL, KPC, NDM), treatment and pathogenesis of K. pneumoniae infections, and possible causes of recurrent UTIs. It also addresses the issue of colonization/becoming a carrier of K. pneumoniae in the gastrointestinal tract and asymptomatic bacteriuria in relation to a symptomatic UTI development and epidemiology.

• Anti-Bacterial Agents/pharmacology
• Anti-Bacterial Agents/therapeutic use
• Drug Resistance, Microbial
• Female
• Humans
• Kidney Transplantation/adverse effects
• Klebsiella Infections/drug therapy
• Klebsiella pneumoniae
• Male
• Urinary Tract Infections/drug therapy
• Urinary Tract Infections/epidemiology
• Virulence
• beta-Lactamases/therapeutic use

Background: CTX-M betalactamases have shown a rapid spread in the recent years among Enterobacteriaceae and have become the most prevalent Extended Spectrum Beta-Lactamases (ESBLs) in many parts of the world. The introduction and dissemination of antibiotic-resistant genes limits options for treatment, increases mortality and morbidity in patients, and leads to longer hospitalization and expensive costs. We aimed to identify the beta-lactamases circulating encoded by the genes bla_CTX-M-15, bla_SHV-1 and bla_TEM-1 in Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) strains. Furthermore, we established the associated resistance phenotypes among patients hospitalized in the Intensive Care Unit (ICU) from County Clinical Emergency Hospital of Craiova, Romania. Methods: A total of 46 non-duplicated bacterial strains (14 strains of E. coli and 32 strains of K. pneumoniae), which were resistant to ceftazidime (CAZ) and cefotaxime (CTX) by Kirby–Bauer disk diffusion method, were identified using the automated VITEK2 system. Detection of ESBL-encoding genes and other resistance genes was carried out by PCR. Results. E. coli strains were resistant to 3rd generation cephalosporins and moderately resistant to quinolones, whereas K. pneumoniae strains were resistant to penicillins, cephalosporins, and sulfamides, and moderately resistant to quinolones and carbapenems. Most E. coli strains harbored bla_CTX-M-15 gene (13/14 strains), a single strain had the bla_SHV-1 gene, but 11 strains harbored bla_TEM-1 gene. The mcr-1 gene was not detected. We detected tet(A) gene in six strains and tet(B) in one strain. In K. pneumoniae strains we detected bla_CTX-M-15 in 23 strains, bla_SHV-₁ in all strains and bla_TEM-1 in 14 strains. The colistin resistance gene mcr-1 was not detected. The tetracycline gene tet(A) was detected in 11 strains, but the gene tet(B) was not detected in any strains. Conclusions. The development in antibiotic resistance highlights the importance of establishing policies to reduce antibiotic use and improving the national resistance surveillance system in order to create local antibiotic therapy guidelines.