CLINICAL AND MICROBIOLOGICAL PROFILE OF URINARY TRACT INFECTIONS IN THE FIRST YEAR POST RENAL TRANSPLANT

Introduction:

Urinary Tract Infections (UTI’s) are a prevalent and serious complication in the first year following renal transplantation. They can adversely affect graft function, increase patient morbidity and result in high healthcare costs. Despite improvements in immunosuppressive and antimicrobial therapies, UTI’s continue to challenge post transplant care, especially with the rise of antibiotic-resistant pathogens. The main objectives of the study are to investigate the incidence, characteristics , clinical outcomes of UTI’s within first year following renal transplantation over a 6 year period, to identify the primary causative pathogens and their antibiotic resistance patterns.

Methods:

A retrospective observational study was conducted involving 125 kidney transplant recipients at Sri Ramachandra University, Chennai who underwent transplantation from January 2017 to June 2023.Medical records were reviewed for demographic data , transplant details, UTI episodes, microbiological findings and outcomes.Statistical analysis was performed to identify risk factors and access impact on graft function.

Results:

Urinary tract infection in renal transplant recipients is a major post transplant complication and it was regulated by several factors such as postoperative medical care, immunosuppressive status, epidemiologic contact, hygiene conditions and socio-economic status. The infection status of renal transplant recipients varies among different centers. In this study 52 (41.6 %) patients out of 125 patients had UTI in first year post renal transplant. Total number of UTI episodes were 80. Klebsiella pneumonia (n=48;60%) was the most frequently isolated pathogen. Other frequently isolated pathogens were Escherichia coli (n=11;13.75%), Pseudomonas (n=6;7.5%), Acinetobacter (n=5;6.25%), Candida (n=5;6.25%), Enterococcus faecalis (n=3;3.25%), Providencia (n=2;2.5%). The incidence is seen more in first 3 months post renal transplant . Among 52 patients with UTI epiosdes, recurrent UTI seen in 19 pts (36.5%) and non recurrent UTI seen in 33 pts (63.5%) with significant graft dysfunction seen in recurrent UTI group .In our study tacrolimus level on day 3, diabetes were found  to have significant association with post transplant UTI. In this study there was no significant association between use of induction agent and post transplant UTI. The number of patients with UTI is higher in recipients from deceased donor. However it did not differ significantly between the groups. Most importantly, urosepsis with impairment of graft function is a potential sequelae of recurrent UTI in transplant recipients. However this study showed no significant association for graft dysfunction between the groups. No significant association between antibiotic resistance and graft function is observed. Among Carbapenem Resistant Organisms (n=20) , CARBA-R test is done which showed resistance mainly to NDM + OXA 48 (n=6), OXA 48(n=5) genes and treated with appropriate antibiotics. The increasing antibiotic resistance observed in common pathogens like Klebsiella (60%), E.coli(13.75%) suggests a re-evaluation of current prophylactic and therapeutic approaches. Candida infection may lead to a serious consequence if its not detected at early stage. In our study 5 patients had candida infection and treated with antifungal agents. This study highlights the importance of early diagnosis and appropriate antibiotic therapy to minimize adverse outcomes.

Conclusions:

Post renal transplant UTIs remain a significant complication with consistent incidence and notable impact on patient and graft outcomes. This study showed that the incidence of urinary tract infection in renal transplant recipients was 41.6% , more in first 3 months. Klebsiella and E.coli were the main pathogens. Graft dysfunction seen more with recurrent UTI group. Diabetes mellitus and tacrolimus level were found to have significantly associated with post transplant UTI . The study emphasizes the need for strategies to address the rising antibiotic resistance and improve clinical management in first year following renal transplant. Enhanced preventive and therapeutic measures are crucial for improving patient and graft survival rates .

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.