Prevalence and risk factors of urinary tract infection in kidney recipients: a meta-analysis study

Abstract

Background A kidney recipient's urinary tract infection (UTI) can result in infectious problems and be a risk factor for less successful transplant outcomes. UTI risk factors are still controversial. The present study aimed to investigate the prevalence of UTI and its association with risk factors in kidney recipients. Method Twenty-six papers published between 2005 and 2022 were retrieved using keywords and searching Medlib, ScienceDirect, PubMed, and other databases. If possible, the pooled prevalence of UTI in kidney recipients and odds ratio (OR) with a 95% confidence interval for each risk factor were calculated. The data were analyzed using the random effects model in R and Stata 14. Results The total sample size was 72,600, with an average age of 48.7 years. The pooled prevalence of UTI was 35% (95% CI, 30–40%). The estimated risk factors for UTI were female (OR = 3.13; 95%CI: 2.35—4.17), older age (OR = 1.03; 95%CI: 1—1.05), history of UTI (OR = 1.31; 95%CI) CI: 1.05—1.63), receiving a kidney from a deceased donor (OR = 1.59; 95%CI: 1.23—2.35), long-term use of an indwelling catheter (OR = 3.03; 95%CI: 1.59—6.59), a ureteral stent (OR = 1.54; 95%CI: 1.16—2.06), diabetes (OR = 1.17; 95%CI: 0.97—1.41), hypertension (OR = 1.6; 95%CI: 1.26—2.28), acute rejection process (OR = 2.22; 95%CI: 1.45—3.4), and abnormal urinary tract anatomy (OR = 2.87; 95%CI 1.44—5.74). Conclusion This meta-analysis revealed that UTIs are a significant problem in kidney recipients. Factors such as female sex, old age, history of UTIs, deceased donor, long-term use of an indwelling catheter, diabetes, acute rejection process, use of ureteral stent, abnormal urinary tract anatomy, and hypertension were related to an increased risk of UTIs in kidney recipients.

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

“…This has been well investigated in a work from Brazil in 2022, where, in line with the later studies, higher age was associated with an increased risk for more UTIs (approximate risk of UTI of 3.6% per year of age) [ 22 ▪▪ ]. Another large meta-analysis from 2023 including 72 600 KTX patients confirmed these results, showing a 3% increase in the odds of experiencing a UTI with each year of age [ 23 ▪▪ ]. However, when looking at some newer studies, such as one from Al Tamimi et al in 2023, age categories including the age >60 were not associated with a higher risk of UTIs [ 24 ].…”

“…The inconsistency in findings among studies may be due to variations in study populations, methodology, and most importantly age category definitions [ 25 ▪▪ ]. To sum up increasing age was confirmed as significant risk factor in six studies [ 3 ▪▪ , 11 ▪▪ , 22 ▪▪ , 23 ▪▪ , 25 ▪▪ , 28 ] comparing to three [ 24 , 29 , 30 ] studies failing to prove this association.…”

“… Risk factors for urinary tract infections in kidney transplant recipients [ 23 ▪▪ , 51 ]. IS, immunosuppression; UTI, urinary tract infection.…”

Spectrum Of Urinary Tract Infection Among Renal Allograft Recipients in a Tertiary Care Centre of Northeast India

“…This nding is consistent with global and Indian studies, which have consistently reported a predominance of gram-negative bacteria, particularly E. coli and Klebsiella species, in UTIs among renal transplant recipients. [24,25] However, the study also reported a concerning trend of antimicrobial resistance, with 12% of isolates being multi-drug resistant (MDR) and 7% being pan-drug resistant (PDR). This nding aligns with the growing global challenge of antimicrobial resistance, which can complicate the management of UTI and contribute to adverse outcomes.…”

Effect of Urinary tract infection on the outcome of the Allograft in patients with Renal transplantation

“…Common risk factors include prolonged indwelling catheters and Double J stents after transplantation, premature discontinuation of antibiotics, short length of transplant ureter, absence of sphincter between transplant ureter and native bladder, and net high dose of immunosuppression immediately post-transplant 5–7 . Risk factors for recurrence include older age, female donor, deceased donor, neurogenic bladder, history of preoperative UTI, and acute rejection episodes (treated with steroids or immunosuppressive regimens) 5–7 . Recurrent UTIs have been reported to occur in 4%-72% of transplant recipients 8 .…”