Urinary tract infections in kidney transplant patients admitted to hospital: A real-life experience

Table 1 Characteristics of enrolled patients

Characteristics		Value
Age in years, median (IQR)		56 (37-72)
Sex, n (%)
	Male	16 (52)
	Female	15 (48)
Comorbidities, n (%)
	Hypertension	27 (87)
	Obesity	15 (48)
	Type II diabetes mellitus	4 (13)
	Cardiovascular disease	2 (6)
	Hypothyroidism	2 (6)
	COPD	1 (3)
Type of transplant, n (%)
	Kidney transplant	30 (97)
	Kidney - pancreas transplant	1 (3)
Indication for the transplant, n (%)
	Chronic renal failure	13 (42)
	ADPKD	8 (27)
	Systemic lupus erythematosus	3 (10)
	IgA nephropathy	2 (6)
	VUR	2 (6)
	Hypertensive nephropathy	2 (6)
	Diabetic nephropathy	1 (3)
Induction immunosuppressive therapy, n (%)
	Basiliximab + methylprednisolone	31 (100)
Immunosuppressive therapy at diagnosis, n (%)
	Tacrolimus – mycophenolate - steroids	16 (52)
	Tacrolimus – everolimus - steroids	3 (10)
	Cyclosporine – mycophenolate - steroids	1 (3)
	Cyclosporine – everolimus - steroids	1 (3)
	Tacrolimus - steroids	6 (20)
	Cyclosporine - steroids	4 (12)
Time from transplant in months, mean (IQR)		49 (2-312)
	TOE	T1
WBC as cell/µL, median (IQR)	14220 (4380-21740)	9885 (3760-15920)
PLT as cell/µL, median (IQR)	379000 (68000-512000)	274000 (83000-492000)
Creatinine in mg/dL, median (IQR)	2.2 (1.5-4.7)	1.9 (1.4-3.5)
Bilirubin in mg/dL, median (IQR)	1.4 (0.9-2.9)	1.1 (0.7-2.3)
CRP in mg/L median (IQR)	55 (9-130)	29 (4-68)

ADPKD: Autosomal dominant polycystic kidney disease; COPD: Chronic obstructive pulmonary disease; CRP: C-reactive protein; IQR: Interquartile range; PLT: Platelets; TOE: Time of enrollment, T1 time of 4 days post-therapy; VUR: Vesicoureteral reflux.

Table 2 Characteristics of urinary tract infections

Items		Value
UTIs, n (%)	cUTIs	22 (71)
	cUTIs and bacteremia	5 (16)
	Urosepsis	4 (13)
Microbiological agents isolated2, n (%)	Escherichia coli ESBL1	10 (32)	Meropenem	6 (19)
			Ertapenem	4 (13)
	Klebsiella pneumoniae ESBL1	6 (19)	Meropenem	4 (13)
			Ertapenem	2 (6)
	Pseudomonas aeruginosa MDR	4 (13)	Meropenem	4 (13)
	Klebsiella pneumoniae no - ESBL	2 (7)	Piperacillin/tazobactam	2 (7)
	Enterococcus faecium VRE	2 (7)	Daptomycin	2 (7)
	Enterococcus faecium Ampi-S	2 (7)	Piperacillin/tazobactam	1 (3)
			Amoxicillin/clavulanate	1 (3)
	Klebsiella pneumoniae CRE	1 (3)	Ceftazidime/avibactam	1 (3)
	Escherichia coli no - ESBL	1 (3)	Piperacillin/tazobactam	1 (3)
	Pseudomonas aeruginosa no - MDR	1 (3)	Ciprofloxacin	1 (3)
	Proteus mirabilis ESBL	1 (3)	Meropenem	1 (3)
	Citrobacter farmeri ESBL	1 (3)	Meropenem	1 (3)
Overall targeted antibiotic therapy, n (%)	Meropenem		15 (48)
	Ertapenem		7 (23)
	Piperacillin/tazobactam		4 (13)
	Daptomycin		2 (7)
	Ciprofloxacin		1 (3)
	Amoxicillin/clavulanate		1 (3)
	Ceftazidime/avibactam		1 (3)
Duration of targeted therapy in days, median (IQR)	14 (7-18)
Length of stay in days, median (IQR)	15 (8-20)
Outcome
Alive	31 (100)

¹Also isolated from blood cultures (3 Escherichia coli extended-spectrum beta-lactamases, 2 Klebsiella pneumoniae extended-spectrum beta-lactamases).

²Isolated from urine culture. Ampi-S: Ampicillin-sensitive; CRE: Carbapenem-resistant Enterobacterales; cUTIs: Complicated urinary tract infections; ESBL: Extended-spectrum beta-lactamases; IQR: Interquartile range; MDR: Multidrug-resistant germ; UTIs: Urinary tract infections; VRE: Vancomycin-resistant Enterococci.

Table 3 Univariate analysis for severe evolution of infection

Parameters	OR	95%CI	P value
Age > 60 years	1.1	0.6-1.4	0.126
Male sex	1.3	0.7-1.6	0.235
Comorbidity
Obesity BMI > 3 kg/m2	1.6	0.9-1.9	0.082
Cardiovascular disease	1.3	0.7-1.5	0.164
Diabetes mellitus	1.5	0.7-1.7	0.143
Triple vs dual immunosuppressive therapy	1.8	1.2-1.9	0.048
History of bacterial colonization	1.3	0.8-1.5	0.174
UTIs in the last 6 months	1.1	0.6-1.3	0.133
MDR microorganism infection	1.5	1.1-1.8	0.044
Appropriate empiric therapy	0.9	0.7-1.1	0.084
Timing between onset of symptoms and hospitalization > 3 days	1.3	0.9-1.8	0.093
Timing of empiric therapy initiation from hospitalization > 2 days	1.5	1.1-1.7	0.047

BMI: Body mass index; MDR: Multidrug-resistant germ; UTI: Urinary tract infection.

Table 4 Multivariate regression analysis for severe evolution of infection

Parameters	OR	95%CI	P value
Age > 60 years	1.3	0.7-1.5	0.158
Male sex	1.2	0.8-1.3	0.231
Comorbidity
Obesity BMI > 30 kg/m2	1.4	0.9-1.6	0.093
Cardiovascular disease	1.3	0.7-1.4	0.334
Diabetes mellitus	1.5	0.7-1.8	0.245
Triple vs dual immunosuppressive therapy	1.6	1.1-1.7	0.046
History of bacterial colonization	1.3	0.8-1.5	0.187
UTIs in the last 6 months	1.4	0.7-1.8	0.132
MDR microorganism infection	1.7	1.2-1.8	0.043
Appropriate empiric therapy	0.9	0.7-1.1	0.083
Timing between onset of symptoms and hospitalization > 3 days	1.5	0.9-1.7	0.092
Timing of empiric therapy initiation from hospitalization > 2 days	1.3	1.1-1.6	0.047

BMI: Body mass index; MDR: Multidrug-resistant germ; UTI: Urinary tract infection.