Introduction:
Urinary tract infections (UTI) are the most common infections after kidney transplantation. The reported incidence of UTI post transplant is from 4-75% varying from center to center. The most important risk factors for early post transplant UTI are directly related to surgical complications, manipulation of urinary tract and structural abnormalities. Increasing patient age, female sex and need for dialysis post transplantation are also known risk factors.
Methods:
Study design: retrospective observational study
Duration: 1st January 2023 to 31st December 2023
Methodology: All kidney transplant recipients’ treatment charts were analyzed for episodes of UTI and other associated factors were analyzed. Recipient factors: age, gender, basic disease (diabetes vs non diabetes) and Treatment factors: immunosuppression, duration of foley’s catheterization in post transplant period, instrumentation of urinary tract post transplant and structural abnormalities. We also analyzed incidence of UTI episodes in ≤6 months and prevalence of causative microorganisms for UTI.
Results:
24/90 (27.8%) patients had UTI with M:F ratio 2:1. 7/24 patients who were age >40 years had developed UTI. 5 (20.8%) patients had received deceased donor renal transplant, 7 (29.1%) had received ABOi live related renal transplant and 13 (54.1%) had received ABOc live related renal transplant. A total of 47 incidents of UTI were noted; 12(25.5%) were culture negative and 35 (74.5%) were culture positive of which 16 (45.7%) grew Klebsiella Pneumoniae, 14 (40%) grew Escherichia Coli, 3 (8.6%) grew Pseudomonas Aeruginosa, 1 (2.1%) grew Enterobacter Cloaca and Enterococcus each. 10/47 (25.9%) incidents occurred in patients who received rATG induction, 16/47 (40.7%) incidents occurred in patients who had ABOi renal transplant and had received Rituximab as the preconditioning regimen. 19/47 were Lower UTI while 28/47 were Upper UTI episodes of which 10 (35.7%) were culture negative, 11 (39.3%) had grown Klebsiella Pneumoniae, 5 (17.8%) had grown Escherichia Coli and 2 (7.2%) had grown Pseudomonas Aeruginosa. Out of 24 patients, 8 (33.3%) had structural abnormality; 7/16 were male had urethral stricture or meatal stenosis and 1/8 was female, who had ureterovesical anastomotic leak. 5/90 patients had undergone urinary tract instrumentation post renal transplant per indication, of which all had developed urinary tract infection. 12/24 patients had recurrent UTI of which 5 patients had structural abnormality of urinary tract as well. 10/26 (38.46%) patients who had foley’s catheter kept insitu >7 days had developed UTI and 14/64 (21.87%) recipients who had initially <7 days of foley’s catheter, had developed UTI. 6/16 (37.5%) patients who had Diabetes Mellitus/NODAT, had developed UTI and 18/74 (24.3%) patients who didn’t have Diabetes Mellitus/NODAT, had developed UTI.
Conclusions:
Post renal transplant UTI is a very common infection, which can lead to substantial hospitalization and increase to the morbidity. It can be reduced with minimization of manipulation/instrumentation of the urinary tract, minimization of immunosuppression, good diabetic control. Most of the microorganisms implicated in UTI are enterobacteriaceae, hence good hygienic practices is also important to prevent UTI in post renal transplant recipients.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.