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Title: | Urinary Tract Infections in the First Year Post-Kidney Transplantation: Potential Benefits of Treating Asymptomatic Bacteriuria. | Authors: | Ryan J. ;Kotagiri P.;Chembolli D.;Hughes P.D.;Toussaint N.D. | Institution: | (Kotagiri, Hughes, Toussaint) The Royal Melbourne Hospital, Parkville, Victoria, Australia (Chembolli, Ryan) Monash Health, Clayton, Victoria, Australia (Ryan) Department of Medicine (Monash Health), Monash University, Victoria, Australia (Hughes, Toussaint) Department of Medicine (RMH), The University of Melbourne, Melbourne, Victoria, Australia | Issue Date: | 23-Nov-2017 | Copyright year: | 2017 | Publisher: | Elsevier USA | Place of publication: | United States | Publication information: | Transplantation Proceedings. 49 (9) (pp 2070-2075), 2017. Date of Publication: November 2017. | Journal: | Transplantation Proceedings | Abstract: | Background Urinary tract infections (UTIs) are the commonest infectious complication in kidney transplant recipients (KTRs). No recommendations exist regarding treatment of asymptomatic bacteriuria. We aimed to identify potential risk factors and microbiological profile for UTIs, the role of treatment of asymptomatic bacteriuria, and effects on graft outcomes of bacteriuria within the first year post-transplantation. Methods We performed a retrospective analysis of UTIs in KTRs transplanted between January 2012 and December 2013 in 2 transplantation centers. Patients were routinely commenced on prophylactic sulfamethoxazole-trimethoprim. Clinical and microbiological data were analyzed for the first year following transplantation. Results In all, 276 KTRs were evaluated; 67% were men, with a mean age of 51 years. At 12 months post-transplantation 158 (57%) KTRs had no bacteriuria, 75 (27%) had asymptomatic bacteriuria, 21 (8%) had symptomatic UTIs without further complication, and 22 (8%) with UTIs developed either pyelonephritis or urosepsis. Most frequent pathogens identified were Enterococcus faecalis and Escherichia coli, and 36% of organisms were multidrug resistant. Female sex was a risk factor for infection (P =.002), and presence of a double-J ureteral stent significantly increased the risk of asymptomatic bacteriuria and symptomatic UTIs (P =.003). Diabetes, age, and prior transplantation did not increase risk. Presence of infection was not associated with increased rejection, with similar renal function at 12 months. For episodes of bacteriuria (n = 420, asymptomatic n = 324), untreated asymptomatic bacteriuria (n = 185) followed by symptomatic UTI with the same organism was significantly higher (P =.002) compared with cases of treated asymptomatic bacteriuria (n = 139). Conclusion Bacteriuria post-kidney transplantation is common, affecting nearly half of KTRs in the first year after transplantation. Treatment of asymptomatic bacteriuria may be beneficial to prevent subsequent episodes of symptomatic UTIs.Copyright © 2017 Elsevier Inc. | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.transproceed.2017.07.008 | Link to associated publication: | Click here for full text options | PubMed URL: | 29149963 [http://www.ncbi.nlm.nih.gov/pubmed/?term=29149963] | ISSN: | 0041-1345 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/38462 | Type: | Article | Subjects: | *asymptomatic bacteriuria bacterium identification diabetes mellitus disease association Enterococcus faecalis Escherichia coli female gender infection risk kidney function *kidney transplantation major clinical study male patient history of transplantation priority journal pyelonephritis retrospective study treatment outcome *urinary tract infection/co [Complication] urosepsis cotrimoxazole ureter stent adult human antibiotic prophylaxis antibiotic resistance article age kidney function *kidney transplantation major clinical study male patient history of transplantation priority journal pyelonephritis retrospective study treatment outcome *urinary tract infection / *complication urosepsis Enterococcus faecalis Escherichia coli diabetes mellitus bacterium identification *asymptomatic bacteriuria Article antibiotic resistance antibiotic prophylaxis age adult disease association female gender human infection risk |
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