Abstract
Urinary tract infection (UTI), frequently caused by uropathogenic Escherichia coli (UPEC), is the most common infection after kidney transplantation (KTx). Untreated, it can lead to urosepsis and impairment of the graft function. We questioned whether the UPEC isolated from KTx patients differed from the UPEC of non-KTx patients. Therefore, we determined the genome sequences of 182 UPEC isolates from KTx and control patients in a large German university clinic and pheno- and genotypically compared these two isolated groups. Resistance to the β-lactams, trimethoprim or trimethoprim/sulfamethoxazole was significantly higher among UPEC from KTx than from control patients, whereas both the isolated groups were highly susceptible to fosfomycin. Accordingly, the gene content conferring resistance to β-lactams or trimethoprim, but also to aminoglycosides, was significantly higher in KTx than in control UPEC isolates. E. coli isolates from KTx patients more frequently presented with uncommon UPEC phylogroups expressing higher numbers of plasmid replicons, but interestingly, less UPEC virulence-associated genes than the control group. We conclude that there is no defining subset of virulence traits for UPEC from KTx patients. The clinical history and immunocompromised status of KTx patients enables E. coli strains with low uropathogenic potential, but with increased antibiotic resistance to cause UTIs.
Highlights
Kidney transplantation (KTx) is the best treatment for patients with end-stage renal disease (ESRD)
Lower Urinary tract infection (UTI) was observed in ~80% of KTx and controls. 24.5% of KTx and 39.3% controls had been hospitalized for UTI (Table 1)
We present the genotypic and phenotypic characteristics of the uropathogenic Escherichia coli (UPEC) isolated from KTx patients first
Summary
Kidney transplantation (KTx) is the best treatment for patients with end-stage renal disease (ESRD). Treatment and prophylaxis, the prevalence of urinary tract infections (UTIs) in KTx patients is high; more than every third patient is affected [1]. While lower UTI/cystitis usually does not limit graft prognosis, pyelonephritis and urosepsis limit the same, in the acute setting, and in the long run, impairing graft function and prognosis [2,3]. Duration of catheterization, acute rejection periods and deceased donor KTx are known risk factors for UTI after KTx [1]. Female patients are at a higher risk for UTIs. Recently, we concluded that a male donor kidney is a new risk factor [4]. Further potential that predisposes host factors are, e.g., excessive immunosuppression, diabetes mellitus, and the instrumentation of the urinary tract [5]
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