Antimicrobial resistance and recurrent bacterial urinary tract infections in hospitalized patients following kidney transplantation: A single‐center experience

Abstract

Purpose The burden of urinary tract infections (UTIs) and risk factors for developing infections with multidrug resistant organisms (MDROs) post‐kidney transplantation (KT) are poorly understood. Methods Single‐center retrospective cohort study (January 2015‐December 2017) evaluating first and recurrent episodes of bacteriuria and subsequent analysis of episodes caused by MDROs up to 6 months post‐KT. Donor and recipient variables were reviewed. Results A total of 743 adults underwent single KT during the study period, and 106 patients were hospitalized with bacteriuria. 45% were asymptomatic in their first episode. 73.6% had a single episode, and 26.4% had 2 or more episodes. A total of 28 patients had recurrent episodes; 64.3% had an MDRO on the first episode and 78.6% on the second episode. Escherichia coli was the most common organism isolated, 88.5% were resistant to trimethoprim‐sulfamethoxazole (TMP‐SMX), 9.3% were extended‐spectrum beta‐lactamase (ESBL) producers, and 38.1% were MDROs. Body mass index ≥30 was significantly associated with the presence of MDROs in both univariate and multivariate analyses (RR 1.37, 95% CI 1.01‐1.88; OR 3.26, CI 1.29‐8.25). A total of 12 donors had bacteremia or bacteriuria and 6 (50%) with E coli. A total of 10 KT recipients received antibiotic prophylaxis to prevent donor‐derived infections. Conclusions Our results suggest that a significant proportion of patients develop recurrent bacteriuria post‐transplantation; of those, more than half caused by MDROs. There is a possible association between obesity and MDROs in KT recipients that merits further investigation. With the global crisis in antimicrobial resistance, innovative strategies are needed to prevent and treat UTIs in KT patients.

Incidence and risk factors for urinary tract infections in the first year after renal transplantation

“…There are many studies showing that urinary tract infections are more common in female recipients [1,4,5]. However, there are also some studies that did not find any difference with respect to gender [7,22,[27][28][29]. Interestingly, in our study, we showed that recurrent urinary tract infections with resistant microorganisms are more common in male transplant recipients.…”

“…Indeed, we believe that following this approach was the major reason for high resistant strain rate in our patients. On antibiotic susceptibility tests, quinolone resistance rate was found to be 64.7%, which is higher than previous studies [21,22]. Greismann S et al showed that quinolone resistance rate was about 47% even though they did not use quinolones for prophylaxis [22].…”

“…On antibiotic susceptibility tests, quinolone resistance rate was found to be 64.7%, which is higher than previous studies [21,22]. Greismann S et al showed that quinolone resistance rate was about 47% even though they did not use quinolones for prophylaxis [22]. In the study published by Behzad D et al, meta-analysis of the antibiotic resistance for gram-negative bacteria suggests that the ciprofloxacin resistance rate was 53.1% [21].…”

“…We stopped prophylactic use of quinolones in our practice in line with study results and recent recommendations that advised the use of single-dose cephalosporin [24,25]. There are also some concerns on prophylactic TMP/ SMX use for the prevention of Pneumocystis jirovecii, since TMP/SMX use may eventuate in increasing antimicrobial resistance especially among uropathogenic microorganisms (22). Singh et al reported administration of TMP/SMX prophylaxis was associated with the significant rise in TMP/SMX resistance rate when comparing kidney transplant recipients without TMP/SMX prophylaxis (89% vs. 48%) [26].…”

“…According to a recently published meta-analysis, more than 50% of isolates causing UTI in kidney transplant recipients were shown to be resistant to more than 50% of the antibiotics used in Middle East countries [21]. Moreover, in another paper from the US published in 2020, 58.5% of the recipients with UTI had at least one episode with MDROs [22]. Thus we can conclude that the increasing rate of MDROs in transplant recipients may be a major concern worldwide in the coming years.…”