Urinary Tract Infection and Kidney Transplantation: A Review of Diagnosis, Causes, and Current Clinical Approach

Castañeda, D.A.; León, Karen Cerinza; Martin, Roger; Rebolledo, Leonardo Andrés López; Pérez, Hernando; Lozano, E.

doi:10.1016/j.transproceed.2013.01.014

Cited by 33 publications

(15 citation statements)

References 35 publications

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“…It is also responsible for about 30% of the sepsis in RTx patients. 2 Early UTI was often associated with acute pyelonephritis and bacteremia, and these could be complicated by acute rejection and the patients’ morbidity and mortality. 1 However, some studies debated whether late UTI had an impact on graft and patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…The UTI incidence in these patients is reportedly between 10% and 98%, and it is a significant source of posttransplant morbidity. 1 , 2 Previous studies have demonstrated that posttransplant UTI is associated with posttransplant graft failure and mortality. 3 , 4 Consequently, several studies have determined independent risk factors for posttransplant UTI, and investigators have found that being a woman, older age, diabetes mellitus, prolonged pretransplantation hemodialysis, cadaveric donors, acute rejection episodes, excessive immunosuppression, and urologic problems are significantly associated with UTI after RTx.…”

Section: Introductionmentioning

confidence: 99%

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Vitamin D Deficiency Is an Independent Risk Factor for Urinary Tract Infections After Renal Transplants

Kwon

Kim

et al. 2015

Medicine

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Vitamin D deficiency is frequently found in patients with renal transplants (RTxs). Because vitamin D plays indispensable roles in the immune system, there may be an association between vitamin D deficiency and infection in these patients, but this has not been fully elucidated. Therefore, this study investigated the impact of pre-RTx vitamin D deficiency on urinary tract infection (UTI) development after RTx.We measured 25-hydroxyvitamin D3 (25(OH)D3) levels in 410 patients 2 weeks before they underwent RTx. Vitamin D deficiency was defined as 25(OH)D3 <10 ng/mL. The primary outcome was UTI occurrence after RTx. Cox proportional hazard analysis determined whether vitamin D deficiency was independently associated with UTI.The mean 25(OH)D3 level was 12.8 ± 6.9 ng/mL, and 171 patients (41.7%) were vitamin D deficient. During a median follow-up duration of 7.3 years, the UTI incidence was significantly higher in vitamin D-deficient patients (52 patients, 30.4%) compared with vitamin D-nondeficient patients (40 patients, 16.7%) (P = 0.001). Moreover, multivariate Cox proportional hazard analysis showed that vitamin D deficiency was an independent predictor of UTI after RTx (hazard ratio 1.81, 95% confidence interval 1.11–2.97, P = 0.02).Vitamin D deficiency was an independent risk factor for UTI after RTx; hence, determining 25(OH)D3 levels might help to predict infectious complications after RTx.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vitamin D Deficiency Is an Independent Risk Factor for Urinary Tract Infections After Renal Transplants

Kwon

Kim

et al. 2015

Medicine

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“…Urinary tract infections (UTI) are the most common of infections after renal transplantation with an estimated incidence between 10 and 98% [1, 2]. The wide variation can be attributed to various factors including inconsistent definitions and diagnostic criteria among studies as well as variable utilisation rates of prophylactic antibiotics.…”

Section: Introductionmentioning

confidence: 99%

“…Intra-operative factors of note include kidney transplantation from a deceased donor, the use of ureteric stents and prolonged indwelling bladder catheterisation. Post-operative factors of note include acute allograft dysfunction and rejection as well as excessive immunosuppression as a result of rejection episodes [1, 8, 9].…”

Section: Introductionmentioning

confidence: 99%

Urinary tract infections in renal transplant recipients at a quaternary care centre in Australia

et al. 2019

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BackgroundUrinary tract infections (UTI) are the most common of infections after renal transplantation. The consequences of UTIs in this population are serious, with increased morbidity and hospitalisation rates as well as acute allograft dysfunction. UTIs may impair overall graft and patient survival. We aimed to identify the prevalence and risk factors for post-transplant UTIs and assess UTIs’ effect on renal function during a UTI episode and if they result in declining allograft function at 2 years post-transplant. Additionally, the causative organism, the class of antibacterial drug employed for each UTI episode and utilisation rates of trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were also quantified.MethodsThis was a retrospective study of 72 renal transplant patients over a 5-year period who were managed at the Royal Brisbane and Women’s Hospital. Patient charts, pathology records and dispensing histories were reviewed as part of this study and all UTIs from 2 years post transplantation were captured.ResultsOf these patients, 20 (27.8%) had at least one UTI. Older age (p = 0.015), female gender (p < 0.001), hyperglycaemia (p = 0.037) and acute rejection episodes (p = 0.046) were risk factors for developing a UTI on unadjusted analysis. Female gender (OR 4.93) and age (OR 1.03) were statistically significant risk factors for a UTI on adjusted analysis. On average, there was a 14.4% (SEM 5.20) increase in serum creatinine during a UTI episode, which was statistically significant (p = 0.027), and a 9.1% (SEM 6.23) reduction in serum creatinine after the UTI episode trending toward statistical significance.(p = 0.076). Common organisms (Escherichia coli and Klebsiella pneumoniae) accounted for 82% of UTI episodes with 70% of UTI cases requiring only a single course of antibiotic treatment. Furthermore, the antibiotic class used was either a penicillin (49%) or cephalosporin (36%) in the majority of UTIs. The use of TMP/SMX prophylaxis for Pneumocystis carinii pneumonia prophylaxis did not influence the rate of UTI, with > 90% of the cohort using this treatment.ConclusionsThere was no significant change in serum creatinine and estimated glomerular filtrate rate from baseline to 2 years post-transplant between those with and without a UTI.

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“…Most of the UTIs occur during the first year after kidney transplantation (7); however, clinical symptoms in kidney transplant patients specific to UTIs, even in severe infections, may be unpronounced due to immunosuppression (8). Because the clinical features are not typical in this population, the first manifestation of UTI among kidney transplant recipients may even be sepsis (9).…”

Section: Introductionmentioning

confidence: 99%

The Prevalence and Risk Factors for Urinary Tract Infection in Kidney Transplant Recipients in the First Year After Transplantation

et al. 2022

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Background: End-stage renal disease (ESRD) needs replacement therapy and most often, kidney transplantation is the best therapeutic option. Urinary tract infection (UTI) is one of the most important complications after renal transplantation that affects transplantation outcomes. Objectives: This study aimed to define the incidence rate, UTI risk factors among kidney transplant recipients, and causative organism of UTI and their antibiotic susceptibility. Methods: In this cross-sectional study, we collected clinical, demographic, and laboratory data from 268 transplant recipients in Ali-Asghar Hospital from 2011 - 2018. Data collected from patients were analyzed with SPSS software version 25. Results: According to the results, 50 (18.7%) had UTI in the first year after renal transplantation. Female gender and underlying cause of renal failure were predisposing factors for UTI. The most common causative organism was Escherichia coli (58.4%). The antibiotic susceptibility results showed nitrofurantoin and meropenem as the most effective antibiotics for Escherichia coli. Conclusions: The UTI was more common in women and patients with analgesic nephropathy and lupus nephritis. The most common causative organism was E. coli and meropenem and nitrofurantoin were the most effective drug choices.

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Urinary Tract Infection and Kidney Transplantation: A Review of Diagnosis, Causes, and Current Clinical Approach

Cited by 33 publications

References 35 publications

Vitamin D Deficiency Is an Independent Risk Factor for Urinary Tract Infections After Renal Transplants

Vitamin D Deficiency Is an Independent Risk Factor for Urinary Tract Infections After Renal Transplants

Urinary tract infections in renal transplant recipients at a quaternary care centre in Australia

The Prevalence and Risk Factors for Urinary Tract Infection in Kidney Transplant Recipients in the First Year After Transplantation

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