Urinary tract infection in renal transplant patients

Abstract

The incidence of urinary tract infections (UTI) in 299 renal graft transplantations (281 patients) was analyzed. UTI episodes were demonstrated in 185 grafts (62%), most frequently in the first month after transplantation. The infectious episodes were mostly recurrent. Persistent infection, detected in 11% of grafts, was associated with urologic complications in almost all cases. No significant correlation between the primary renal disease and the UTI rate was found, and there was no significant correlation between UTI and sex. In grafts with recurrent infectious episodes, vesicoureteral reflux was more common. No significant difference was observed in the residual bladder volume, irrespective of whether infection was present or not. The urine was infected by a number of hospital strains, particularly Klebsiella, Enterobacter and indole-positive Proteus strains. An overwhelming majority of UTI episodes (96%) were asymptomatic. Antibody-coated bacteria in urinary sediment were present in only 19% of infectious episodes. Clinically severe courses were observed in infections associated with urologic complications (especially urinary fistulae); these were difficult to treat and were often a source of sepsis and a risk factor in graft loss.

Asymptomatic Bacteriuria: Significance for Different Patient Population

“…In this study, 91% of the patients were asymptomatic and 57% of the infections occurred within 1 month, and approximately 80% by 6 months (Ramsey et al, 1979). In another study by Prat et al, 185 of 299 kidney transplant patients had at least one episode of infection with 96% of the episodes asymptomatic (Prat et al, 1985). Patients with persistent infection and urologic complications often experienced sepsis and graft loss.…”

Chronic Allograft Nephropathy

“…Urinary tract infection is a common complication following renal transplantation (Prat et al, 1985, Abbott et al, 2001). Graft pyelonephritis is well recognized to cause graft dysfunction but the longer-term impact is less clear (Pelle et al, 2007).…”

Bacterial Infections after Renal Transplantation

“…Other uropathogens are Enterobacter species, enterococci, S o latia, Acinetobacter, Citrobacter. and Pseudomonas aeru ginosa [34], There is a report about stone formation due to P. mirabilis as uncommon complication in renal allograft recipients [36], However, stone formation due to ureaseforming microorganisms such as Proteus mirabilis, Pro teus vulgaris. Pseudomonas aeruginosa.…”

“…In the normal population, urinary tract infections arc due to E. coli in 80%. In kidney transplant recipients this organism is only involved in 29% [34] to 61 % [35]. Proteus mirabilis and Klebsiella pneumoniae were positive in 30% and gram-positive cocci in 20% of the urine cultures.…”

“…The mean time for acquisition is 7 days (range 3-11) [37], In the study of Kentouni-Noly et al [37], mean hospital stay was 27 days in the absence of infection, and 36 days in patients with urinary tract infection. Also in pediatric patients urinary tract infections were most frequent in the first 6 months after renal transplantation [38], 80% of the infections were located in the lower urinary tract [4,34], mostly without clinical symptoms.…”