Urinary Tract Infections in the First Year Post Kidney Transplantation.

Abstract

Background: Urinary tract infections (UTI) are the commonest infectious complication in kidney transplant recipients (KTRs). Effects on graft function are unclear. No recommendations exist regarding treatment of asymptomatic bacteriuria but concern that immunosuppression and denervation of the graft masks symptoms often prompts treatment. We aimed to identify potential risk factors for UTIs, microbiological profile and role of treatment of asymptomatic bacteriuria, and effects on graft outcomes. Method(s): Retrospective analysis of UTIs in KTRs transplanted between Jan 2012 and Dec 2013 in two Australian tertiary transplant centres where patients are routinely commenced on prophylactic sulfamethoxazole/trimethoprim. Clinical and microbiological data was analysed for the first year following transplantation. Result(s): 276 KTRs were evaluated, 67% male, mean age of 51yrs. 158 recipients (57%) had no bacteriuria in the first year post-transplant, 75 (27%) had only asymptomatic bacteriuria, 21 (8%) had symptomatic UTIs and 22 (8%) with UTIs developed either pyelonephritis or urosepsis. Most frequent pathogens identified were Enterococcus Faecalis and Escherichia Coli, and 36% were multi-drug resistant. Female gender was a risk factor for infection (p=0.002) and presence of a ureteric JJ stent significantly increased the risk of asymptomatic bacteriuria and symptomatic UTIs (p=0.003). Diabetes, age and prior transplantation did not increase risk. Presence of infection was not associated with increased rejection or adverse longer-term outcomes with similar renal function at 12 months. For all episodes of bacteriuria in our cohort (n=420), cases of untreated asymptomatic bacteriuria (n=185) followed by symptomatic UTI with the same organism were significantly higher (p=0.002) compared to cases of treated asymptomatic bacteriuria (n=139). Conclusion(s): Treatment of asymptomatic bacteriuria in the first year post-transplant may be beneficial to prevent subsequent episodes of symptomatic UTIs.