|
1
|
Pinchera B, Carrano R, Schettino E, D'Agostino A, Trucillo E, Cuccurullo F, Salemi F, Piccione A, Gentile I. Urinary tract infections in kidney transplant patients admitted to hospital: A real-life experience. World J Transplant 2025; 15:99554. [DOI: 10.5500/wjt.v15.i2.99554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Revised: 11/07/2024] [Accepted: 11/28/2024] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) in kidney transplant patients are a challenge.
AIM To evaluate epidemiology, clinical status, therapeutic management, and clinical outcome of kidney transplant patients in a university hospital for UTI.
METHODS 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.
RESULTS 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.
CONCLUSION Prompt initiation of empiric antibiotic therapy upon initiation of microbiological investigations may reduce the risk of severe infection progression.
Collapse
Affiliation(s)
- Biagio Pinchera
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples 80131, Italy
| | - Rosa Carrano
- Section of Nephrology, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Elisa Schettino
- Section of Nephrology, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Alessia D'Agostino
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples 80131, Italy
| | - Emilia Trucillo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples 80131, Italy
| | - Federica Cuccurullo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples 80131, Italy
| | - Fabrizio Salemi
- Section of Nephrology, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Amerigo Piccione
- Section of Nephrology, Department of Public Health, University of Naples “Federico II”, Naples 80131, Italy
| | - Ivan Gentile
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples 80131, Italy
| |
Collapse
|
|
2
|
Sharma M, Qanoongo FN, Doley PK, Pegu G, Pegu M. Spectrum and impact of urinary tract infections among adult renal allograft recipients in a tertiary care center of Northeast India. Int Urol Nephrol 2025:10.1007/s11255-025-04571-6. [PMID: 40404929 DOI: 10.1007/s11255-025-04571-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 05/06/2025] [Indexed: 05/24/2025]
Abstract
BACKGROUND Urinary tract infections (UTI) pose a significant threat to renal allograft recipients (RARs), jeopardizing graft function and patient survival. This study aimed to investigate the incidence, microbiological profile, risk factors, and impact of UTI on renal allograft outcomes. METHODS A retrospective cohort study was conducted at a tertiary care center in Assam, India, from July 2022 to January 2024, including 220 RARs aged over 18 years. Detailed clinical, microbiological, and outcome data were collected and analyzed. Multivariate logistic regression was performed to identify independent risk factors. RESULTS The incidence of UTI was 55/220, (25%), with a higher incidence in females 32/55 (58%). The highest incidence occurred within the first 3 months post-transplant (42.3%), followed by 4-6 months (34.6%), and beyond 6 months (23.1%). Asymptomatic bacteriuria 25/55 (45%) and cystitis (19/55 (35%) were the most common UTI types. Escherichia coli 22/55 (44%) and Klebsiella pneumoniae 18/55 (32%) were the predominant uropathogens, with 7/55 (12%) of isolates being multi-drug resistant (MDR) and 4/55 (7%) pan-drug resistant (PDR). Female gender [odds ratio (OR) 6.73, 95% confidence interval (CI) 4.53-12.65, p < 0.001)], prolonged Foley's catheterization (OR 3.92, 95% CI 2.95-4.88, p = 0.019), and urinary tract abnormalities (OR 2.83, 95% CI 1.61-4.17, p = 0.027) emerged as significant independent risk factors. UTI led to acute graft dysfunction in 54% (30/55) of cases, and 3% (2/55) underwent graft nephrectomy. However, 76% (23/30) of patients with acute graft dysfunction due to UTI achieved complete recovery with management. CONCLUSIONS This study on UTI in renal transplant recipients in India found a 25% incidence rate, highest within the first 3 months post-transplant. Asymptomatic bacteriuria was common, despite UTI-related graft challenges, most acute dysfunctions resolved with management. Female gender, prolonged catheterization, and urinary tract abnormalities were significant risk factors.
Collapse
Affiliation(s)
- Manjuri Sharma
- Department of Nephrology, Gauhati Medical College, Guwahati, Assam, India
| | | | - Prodip Kumar Doley
- Department of Nephrology, Gauhati Medical College, Guwahati, Assam, India
| | - Gayatri Pegu
- Department of Nephrology, Gauhati Medical College, Guwahati, Assam, India
| | - Miranda Pegu
- Department of Nephrology, Gauhati Medical College, Guwahati, Assam, India
| |
Collapse
|
|
3
|
El Hennawy HM, Safar O, El Madawie MZ, Gopiechand J, Tawhari I, Nazer WE, Zaitoun MF, Faifi ASA. Clinical and financial impacts of nursing education programs on recurrent urinary tract infections after kidney transplant: a cohort study. BMC Nephrol 2025; 26:232. [PMID: 40346466 PMCID: PMC12065213 DOI: 10.1186/s12882-025-04153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2024] [Accepted: 04/25/2025] [Indexed: 05/11/2025] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are the most prevalent infections among kidney transplant recipients, with recurrent cases imposing a significant financial burden due to increased hospitalizations and treatment costs. OBJECTIVE This study aims to investigate the incidence of recurrent UTIs and evaluate the financial impact of a comprehensive nursing education initiative. METHODS A retrospective cohort study was conducted with kidney transplant patients, divided into two groups: a control group prior to the intervention and a study group following the implementation of the education program. The intervention consisted of weekly training sessions focusing on infection prevention, catheter care, and hygiene. Patient outcomes were monitored for one year post-transplant, with a focus on UTI rates, patient adherence, knowledge, and healthcare costs. RESULTS The nursing education program resulted in a 26% reduction in UTI incidence and decreased average hospital stays from 8 days to 4 days. Healthcare costs per admission fell from $10,000 to $6,000, leading to total savings of $700,000 based on 175 admissions. The program resulted in a net saving of $650,000. Additionally, significant improvements were observed in patient knowledge, satisfaction, and compliance. CONCLUSIONS Nursing education on UTI prevention for kidney transplant patients effectively enhances clinical outcomes and reduces healthcare costs. These findings underscore the importance of integrating structured education programs into transplant care protocols to achieve sustainable health and economic benefits. CLINICAL TRIAL NUMBER Not Applicable.
Collapse
Affiliation(s)
- Hany M El Hennawy
- Surgery Department, Section of Transplantation, Armed Forces Hospitals, Southern Region, Khamis Mushayte, KSA, 101, Saudi Arabia.
| | - Omar Safar
- Urology Department, Armed Forces Hospitals, Southern Region, Khamis Mushayte, KSA, 101, Saudi Arabia
| | - Mahmoud Z El Madawie
- Urology Department, Armed Forces Hospitals, Southern Region, Khamis Mushayte, KSA, 101, Saudi Arabia
| | - Jayson Gopiechand
- Nursing Department, Armed Forces Hospitals, Southern Region, Khamis Mushayte, KSA, 101, Saudi Arabia
| | - Ibrahim Tawhari
- Department of Internal Medicine, King Khalid University College of Medicine, Abha, KSA, 61421, Saudi Arabia
| | - Weam El Nazer
- Nephrology Department, Armed Forces Hospitals, Southern Region, Khamis Mushayte, KSA, 101, Saudi Arabia
| | - Mohammad F Zaitoun
- Pharmacy Department, Armed Forces Hospitals, Southern Region, Khamis Mushayte, KSA, 101, Saudi Arabia
| | - Abdullah S Al Faifi
- Surgery Department, Section of Transplantation, Armed Forces Hospitals, Southern Region, Khamis Mushayte, KSA, 101, Saudi Arabia
| |
Collapse
|
|
4
|
Meng F, Zhu C, Zhu C, Sun J, Chen D, Ding R, Cui L. Epidemiology and pathogen characteristics of infections following solid organ transplantation. J Appl Microbiol 2024; 135:lxae292. [PMID: 39567858 DOI: 10.1093/jambio/lxae292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 09/19/2024] [Accepted: 11/19/2024] [Indexed: 11/22/2024]
Abstract
Solid organ transplantation (SOT) recipients have a heightened risk for infection due to prolonged immunosuppressive drug use following transplant procedures. The occurrence of post-transplant infections is influenced not only by the transplanted organ type but also by varied factors. The kidney is the most common organ in SOT, followed by the liver, heart, and lung. This review aims to provide a comprehensive overview of the current epidemiological characteristics of infections after kidney, liver, heart, and lung transplantation, focusing on bacterial, fungal, and viral infections. The incidence and infection types demonstrated significant variability across different SOTs. Furthermore, this review attempts to elucidate the clinical characteristics of infections across patients following different SOTs and contribute to the development of individualized prevention strategies according to infection incidence, ultimately enhancing the quality of life of transplant recipients.
Collapse
Affiliation(s)
- Fanjie Meng
- Clinical Laboratory, Yidu Central Hospital of Weifang, Weifang 262500, China
| | - Chi Zhu
- The State Key Laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing 210042, China
- Department of Medicine, Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing 210042, China
| | - Chan Zhu
- The State Key Laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing 210042, China
- Department of Medicine, Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing 210042, China
| | - Jiaxuan Sun
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT 06520, United States
| | - Dongsheng Chen
- The State Key Laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing 210042, China
- Department of Medicine, Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing 210042, China
- Cancer Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, China
| | - Ran Ding
- The State Key Laboratory of Neurology and Oncology Drug Development, Jiangsu Simcere Diagnostics Co., Ltd, Nanjing 210042, China
- Department of Medicine, Nanjing Simcere Medical Laboratory Science Co., Ltd, Nanjing 210042, China
- Cancer Center, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou 121001, China
| | - Liyuan Cui
- Department of Thoracic Surgery, Linyi People's Hospital, Linyi 276000, China
| |
Collapse
|
|
5
|
Al Tamimi AR, Alotaibi WS, Aljohani RM, Aldharman SS, Alharbi NM, Khair HS. The Impact of Urinary Tract Infections in Kidney Transplant Recipients: A Six-Year Single-Center Experience. Cureus 2023; 15:e44458. [PMID: 37791170 PMCID: PMC10544306 DOI: 10.7759/cureus.44458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 10/05/2023] Open
Abstract
Background Urinary tract infections (UTIs) are the most common infections following kidney transplantation. Risk factors for UTIs in kidney transplant recipients include female gender, age, pre-transplant urinary tract abnormalities, diabetes, and recurrent UTIs. Infections of the bladder or urethra are termed lower UTIs, while those involving the kidneys or ureters are called upper UTIs. Methods We retrospectively screened our hospital information system to identify all patients who underwent kidney transplantation in the surgery department at King Abdulaziz Medical Center in Riyadh. A total of 553 records were ultimately included in the final analysis. Results A total of 553 patients were ultimately included in the analysis. More than half of the patients were males (62.4%), and 31.1% were aged between 45 and 60 years. Of these, 230 patients had a UTI, representing 41.59% of the sample. The most commonly reported causes were hypertensive nephrosclerosis (43.4%) and diabetic nephropathy (28.8%). The most frequently isolated causative agents were Escherichia coli (51.0%) and Klebsiella pneumoniae (21.8%). UTIs were significantly more prevalent among females, accounting for 73.6% of cases. Antibiotics were used in 86.5% of patients, with trimethoprim/sulfamethoxazole (65.8%) and ciprofloxacin (54.8%) being the most commonly prescribed. Conclusion About half of the patients in this study suffered from UTIs. E. coli and K. pneumoniae were the most commonly isolated organisms. Trimethoprim/sulfamethoxazole and ciprofloxacin were the most frequently prescribed antibiotics. A significant association was found between acquiring a UTI and being female (p < 0.001), as well as having pre-existing bladder dysfunction (p = 0.024).
Collapse
Affiliation(s)
- Abdulrahman R Al Tamimi
- Hepatobiliary Sciences and Organ Transplantation, King Abdulaziz Medical City, Riyadh, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Wed S Alotaibi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Renad M Aljohani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Sarah S Aldharman
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Noof M Alharbi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Haneen S Khair
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
- Research, King Abdullah International Medical Research Center, Riyadh, SAU
| |
Collapse
|
|
6
|
Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis. Biomedicines 2022; 10:biomedicines10112984. [PMID: 36428552 PMCID: PMC9687497 DOI: 10.3390/biomedicines10112984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/04/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022] Open
Abstract
Risk factors and consequences of urinary tract infection (UTI) post-kidney transplant have been variously reported by studies that were heterogenous in immunosuppressants and prophylactic protocols. We aimed to clarify the risks and consequences of UTI in kidney transplant recipients with post-transplantation cotrimoxazole prophylaxis in the context of modern immunosuppression. This retrospective cohort included kidney transplant recipients receiving tacrolimus, mycophenolate, prednisolone, and cotrimoxazole for bacterial UTI prophylaxis. Recipients were categorized into non-UTI and UTI groups. Asymptomatic bacteriuria (ASB) was screened in the first 3 months and was evaluated for association with UTI. Of 348 kidney transplant recipients, 129 were in the UTI group and 219 in the non-UTI group. UTI risk factors were female sex, body mass index ≥ 25 kg/m2, human leukocyte antigen mismatch, and panel reactive antibody ≥ 50%. Recipients with recurrent UTI had inferior allograft function compared with non-UTI recipients. Patient survival was significantly lower in recipients with UTI in the first post-transplant month. Higher degree of immunosuppressions was associated with recurrent UTI and drug-resistant organisms. In conclusion, UTI continues to negatively affect graft function and survival of kidney transplant recipients. Treating ASB in the first 3 months did not reduce the UTI incidence in the first transplantation year.
Collapse
|
|
7
|
Ma ZZ, Yang HJ, Pan X, Duan YD, Li L, Xiao Y, Cao MY, Qian CY, Niu ME. Construction of a nursing solution to prevent and control urinary tract infection in the early stages of kidney transplantation. Transl Androl Urol 2022; 10:4392-4401. [PMID: 35070821 PMCID: PMC8749069 DOI: 10.21037/tau-21-926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Abstract
Background To construct a nursing solution for the prevention and control of urinary tract infection (UTI) in the early stage after kidney transplantation, and to provide systematic and standardized nursing intervention measures for patients in the early stage after kidney transplantation. Methods The preliminary draft of intervention plan was formulated based on risk factor analysis research results of early UTI after kidney transplantation, combined with theoretical research, literature review, and research group meeting. The Delphi method was used to consult 15 experts for two rounds, and the entries were modified according to the opinions of the experts. Results After two rounds of consultation, the expert opinions tended to be consistent, and expert authority coefficient was 0.87. The Kendall harmony coefficient of importance and feasibility indexes of the two rounds of consultation were 0.407, 0.651 and 0.545, 0.686, respectively, with statistically significant differences (P<0.001). The nursing solution consisted of eight first-level indexes and 35 second-level indexes. The eight first-level indexes included admission symptom evaluation, UTI monitoring, health education, sports intervention, nutrition intervention, ward management, risk factor prevention and nursing, and psychosocial intervention. Conclusions This study constructed a scientific and reliable nursing solution for the prevention and control of early UTI after kidney transplantation, which is hugely important for guiding clinical nursing work.
Collapse
Affiliation(s)
- Zheng-Zheng Ma
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hu-Juan Yang
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xi Pan
- Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ya-Dong Duan
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Li
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Xiao
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meng-Yi Cao
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chun-Ya Qian
- Department of Urology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Mei-E Niu
- Department of Nursing, the First Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
|
8
|
Updates on urinary tract infections in kidney transplantation. J Nephrol 2019; 32:751-761. [PMID: 30689126 DOI: 10.1007/s40620-019-00585-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/09/2019] [Indexed: 01/20/2023]
Abstract
Urinary tract infection (UTI) represents the most common infection after kidney transplantation; it is associated with an increased risk for acute kidney rejection and impaired graft function in the early post-transplant period. Kidney transplant recipients with UTIs are often clinically asymptomatic due to the immunosuppressive therapy; however, asymptomatic bacteriuria may progress to acute pyelonephritis, bacteremia and urosepsis, particularly in the early post-transplant period, that are independent risk factors for short and long-term graft and patient survival. This article reviews the definitions, incidence, risk factors and the management of UTI in kidney transplant recipients; furthermore, the main controversial and still unanswered questions, regarding the causes of recurrent UTIs, adequate use of antibiotics to avoid antibiotic resistance, dosing and timing for prophylaxis and treatment of symptomatic infections, are also discussed. The emerging definition of urinary microbiota introduces new concepts in understanding the complexity of the disease and might represent the future target for therapeutic interventions.
Collapse
|