Urinary Tract Infection In Renal Transplant Recipients Research Articles

Outcomes of Bladder Washout for the Treatment of Recurrent Urinary Tract Infections After Renal Transplantation.

Background Current literature suggests that anywhere from 2.9-27% of renal transplant recipients (RTR) will develop recurrent urinary tract infections (UTIs) (≥2 UTIs over six months or ≥3 UTIs over 12 months). Recurrent UTIs are of particular importance to RTR given its increased risk for allograft fibrosis and overall patient survival. Alternative solutions are needed for the management of recurrent UTIs, especially given the vulnerability of RTR to UTIs. We hypothesize that bladder washout (BW) reduces the incidence and recurrence of UTIs in RTR. Methods This is a retrospective study evaluating the utility of BW procedures on RTR diagnosed with recurrent UTIs between December 2013 and July 2021 at a single center. Results A total of 106 patients were included in the study with a total of 118 BW performed. 69% of patients were successfully treated with BW, meaning they no longer met the criteria for recurrent UTIs (<1 UTI) in the six-month post-BW period. The mean number of UTIs was 2.76 (range 2-7) before the BW and 1.16 (range 0-5) after the BW. On average, there were 1.60 fewer UTIs in the post-BW period compared to the pre-BW period (p<0.0001). There is no statistically significant difference in success rates stratified by bacterial class (p=1) or antimicrobial resistance class (p=0.6937). Conclusion BWdecreased the incidence of UTIs in the six-month post-operative period as nearly 70% of patients did not have UTI recurrence. This data provides evidence that BW may have utility in transplant recipients with recurrent UTIs. We hope this will stimulate further prospective randomized studies in this area.

Overview on urinary tract infection, bacterial agents, and antibiotic resistance pattern in renal transplant recipients.

Background:Urinary tract infection (UTI) is a mainly common infection in kidney transplant recipients. This study decided to investigate UTI, bacterial agents, and antibiotic resistance pattern in kidney transplant recipients from Iran.Materials and Methods:Search process was conducted for UTI, bacterial agents, and antibiotic resistance pattern in kidney transplant recipients from Iran via electronic databases (Scopus, PubMed, Web of Science, etc.,) with Mesh terms in either Persian and English languages without limited time to May 31, 2020. Data were analyzed by comprehensive meta-analysis software.Results:The combined prevalence of UTI in renal transplant recipients was reported by 31.1%. The combined prevalence of Gram-negative bacteria was 69%. The most common pathogens among Gram negatives were E. coli followed by Klebsiella pneumoniae with frequency 43.4% and 13%, respectively. Subgroup analysis for Gram-positive bacteria showed the combined prevalence of 31%. The most common microorganism among Gram positives belonged to coagulase-negative Staphylococci and Enterococci with a prevalence of 10.2% and 9%, respectively. Subgroup meta-analysis of antibiotic resistance for Gram-negative showed the most resistance to cephalexin followed by carbenicillin with a prevalence of 89.1% and 87.3%, respectively.Conclusion:Our review showed a noticeable rate of UTI (31.1%) among renal transplant recipients in Iran and a high prevalence of Gram-negative (69%) and Gram-positive (13%) microorganisms. A high resistance rate was seen against almost all antibiotics used for the treatment of UTI. Therefore, empirical prescription of antibiotics should be avoided, and it should be based on data obtained from antibiogram tests.

P1742POTENTIAL TREATMENT METHOD OF RECURRENT URINARY TRACT INFECTION IN POSTMENOPAUSAL KIDNEY TRANSPLANT RECIPIENTS: THE RESULTS OF PILOT STUDY

Abstract Background and Aims Infectious complications remain a major cause of morbidity and mortality among transplant recipients. Urinary tract infection (UTI), especially recurrent UTI, is a common problem, with the prevalence up to 75% among kidney transplant (KTx) recipients. Older age, female gender and delayed graft function are among the independent risk factors for recurrent UTIs in renal transplant recipients*. Postmenopausal women with recurrent UTI after KTx especially caused by bacteria with multidrug antibiotic resistance (MDR) form a large and growing up group of patients with almost unachievable remission. The aim of the study was to assess the efficiency of different treatment schemes of recurrent UTI in postmenopausal female transplant recipients. *prospective study presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy Method The randomized prospective pilot study was conducted to assess the efficiency of 3 different therapy schemes, study period: 2017-2019. Recurrent UTIs were defined as ≥2 UTIs in 6 months or ≥3 UTIs in 12 months. A UTI was diagnosed based upon the presence of pyuria defined as &amp;gt;5 WBCs/high-power field and a urine culture of &amp;gt;100,000 colonies/mL. All consecutive female patients with postmenopausal history who presented to the transplant clinic for follow-up over the study period of six months were prospectively randomized into 3 groups. The primary outcome was occurrence of UTI at 6 months. Results Escherichia coli was the responsible pathogen for recurrent UTI in 55% of cases. Other causative organisms include Klebsiella pneumoniae (35%) as well as Enterobacter spp (10%). The rate of resistance to all tested antibiotics was the highest in Klebsiella pneumoniae. The first episode of UTI occurred at 16 (8,5;42) week after KTx. The total number of UTI episodes (per year) after treatment varies from 7 [5;8] in the 1st Group to 0 [0;0] at the 3rd Group (p&amp;lt;0,001), in which 13 out of 15 patients achieved long-term remission during the observation period. Clinical data on the 1st check-up after treatment course and about UTI episodes are given bellow. Conclusion Frequent antibiotic usage often causes MDR as well as result in intestinal dysbacteriosis. Immunosuppression state, frequent antibiotic usage, intestinal disbiosis and also vaginal Ph decline form pathogenic vicious circle. Complex usage of fosfomycin that remains active against a considerable proportion of MDR gram-negative bacteria with bacteriophages, estrogen treatment and long-term probiotic supplement may reduce the UTI frequency in postmenopausal women after KTx.

Fosfomycin for post-renal transplant urinary tract infection: Re-emergence of an old drug - a Case report

Urinary tract infection (UTI) is a common problem in renal transplant recipients (RTR). It is challenging to treat UTI in RTR, as they are immunosuppressed, prone to allograft dysfunction, and can have adverse drug interactions due to the concomitant use of other immunosuppressant drugs. The UTI in RTR may present as asymptomatic bacteriuria (ASB), cystitis, pyelonephritis, or asymptomatic allograft dysfunction. Many times, UTI is caused by drug-resistant organisms, making it difficult to treat and also limiting the choice of empirical and specific antimicrobial therapy. Besides this, the treatment of ASB is controversial in RTR. Fosfomycin is an old drug which is re-emerging as an empirical antibiotic for UTI. Herein, we report a patient with multidrug-resistant ASB, within 1st month of transplant treated successfully with a single dose of fosfomycin.

Clinical profile and predisposing factors for the development of urinary tract infection during the first 3 months postrenal transplantation: A tertiary care hospital experience

Background: Infections in renal allograft recipients, especially urinary tract infections (UTI), are an essential factor leading to an increase in morbidity, graft failure, and degrading the health-related quality of life. Aims and Objectives: Our objective is to assess the causes, risk factors, microbiological profile, and antibiotic sensitivity pattern of UTI in renal transplant recipients. Material and Methods: It was a prospective observational study, conducted at the Department of Nephrology, Sir Gangaram Hospital, New Delhi, India. Three hundred ten renal transplant recipients were enrolled. Results: Out of 300 transplant recipients, 107 (35.6%) had UTI. The mean age of patients with UTI was 32 ± 10.5 years. Females have a higher incidence of UTI than males. 64.5% of all diabetic patients had UTI. Escherichia coli (41%) was the most common causative agent. Gram-negative bacilli attributed the majority (88.5%) of cases. Klebsiella pneumonia was found to be multidrug-resistant in most cases. 61% of patients with reflux kidney disease before transplant suffered from UTI. Conclusion: On multivariate analysis in our study, diabetes (P=0.01), prolonged urethral catheterization (p=0.002), and double J stent kept in situ (p=0.03) and reflux kidney disease before transplant (p

Urinary tract infection in renal transplant recipients at a tertiary care center in India.

Our objective was to determine incidence, predisposing factors, and microbiological profile of urinary tract infection (UTI) in renal transplant recipients in our center. This was cross-sectional observational study, conducted at the Department of Nephrology, Army Hospital Research and Referral, Delhi, India. Two hundred and ten renal transplant recipients were studied over one year. Out of 210 transplant recipients, 69 (32.86%) had UTI. Majority (59/69) had undergone live renal transplantation and 10 cases had received cadaveric grafts. Forty-nine patients had primary infection while 20 patients had recurrences. The mean age of patients with UTI was 38.63 ± 10 years. The incidence of UTI was higher in females (42.25%) than males (28.06%, P = 0.038). Majority of patients in younger age group (age <30 years) were female (58.82%). Males were predominantly affected in higher (>30 years) age group (61.54%). Most common causative agent was Escherichia coli (72.46%). Gram-negative bacilli accounted for 94.20% (65/69) while Gram-positive cocci for 5.8% (4/69) of positive cultures. Multidrug resistance was highest in Klebsiella pneumoniae (100%). Fifteen cases with UTI were detected to have underlying urinary tract abnormalities, most common being urethral stricture (60%). One patient was detected to have broken double J stent in the renal pelvis which led to recurrent E. coli infection. Forty-eight patients (69.57%) developed acute graft dysfunction secondary to UTI. Female sex (P = 0.038), urinary tract abnormality (P <0.01), prolonged Foley's catheterization (P <0.01), prolonged hospitalization after transplantation (P <0.01), new-onset diabetes after transplantation (P <0.01), and coexisting hepatitis C infection (P = 0.012) were statistically significant predisposing factors for UTI in renal transplant recipients.

MP26-15 SYMPTOMATIC URINARY TRACT INFECTIONS IN RENAL TRANSPLANT PATIENTS AFTER CYSTOSCOPY FOR URETERAL STENT REMOVAL

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder II1 Apr 2016MP26-15 SYMPTOMATIC URINARY TRACT INFECTIONS IN RENAL TRANSPLANT PATIENTS AFTER CYSTOSCOPY FOR URETERAL STENT REMOVAL Justin Gregg, Caroline Kang, Thomas Talbot, S. Duke Herrell, Roger Dmochowski, and Daniel Barocas Justin GreggJustin Gregg More articles by this author , Caroline KangCaroline Kang More articles by this author , Thomas TalbotThomas Talbot More articles by this author , S. Duke HerrellS. Duke Herrell More articles by this author , Roger DmochowskiRoger Dmochowski More articles by this author , and Daniel BarocasDaniel Barocas More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2952AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Symptomatic urinary tract infection (UTI) is a known complication of cystoscopy with ureteral stent removal. However, little is known about the incidence and risk factors for post-cystoscopy UTI in renal transplant recipients, who likely represent a high-risk cohort. Our aim was to determine the infection rate following cystoscopy with stent removal in this population and identify opportunities for care improvement. METHODS We performed a retrospective cohort study of office cystoscopies with stent removal in renal transplant recipients performed at a single institution from April 2012 through May 2014. Symptomatic UTI was defined as having a single symptom (fever, urgency, frequency, dysuria, prostate tenderness or suprapubic tenderness) with a culture of 10^5 or more colony-forming units (CFU) per high-power field, or two symptoms with other characteristics such as a positive urinalysis or physician-diagnosed UTI within one month of procedure. Fisher's exact tests were completed to examine associations between patient characteristics (age, race, diabetes, smoking history, prednisone use, and deceased or living donor) and post-transplant outcomes (time to stent removal, readmission, non-genitourinary tract infection, delayed graft function, acute cellular rejection, and post-procedure urinary leak). Use of pre-procedural antibiotics in addition to daily prophylactic trimethoprim/sulfamethoxazole or dapsone was also evaluated. RESULTS A total of 324 patients underwent outpatient cystoscopy with stent removal. Mean age was 50.0 (SD 13.1) years, and 187 (57.7%) patients were male. Within this group, 200 (61.7%) patients underwent stent removal within four weeks of transplant. 165 (52.5%) patients received a pre-procedural oral fluroquinolone antibiotic dose prior to the procedure. Nine patients had symptomatic UTIs (2.8%), of which three infections (33.3%) were due to quinolone-resistant organisms. Univariate analyses revealed that female sex (P =0.04), was associated with symptomatic UTI. No other patient characteristic or post-operative outcome was associated with symptomatic UTI, including the use of peri-procedural antibiotics. CONCLUSIONS The incidence of symptomatic UTI after cystoscopy with ureteral stent removal in renal transplant recipients is less than three percent and comparable to post-cystoscopy UTI risk in the general population. Female sex is associated with symptomatic UTI. Further investigation is needed to identify groups most at risk for UTI and other complications. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e359 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Justin Gregg More articles by this author Caroline Kang More articles by this author Thomas Talbot More articles by this author S. Duke Herrell More articles by this author Roger Dmochowski More articles by this author Daniel Barocas More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP32-14 CYSTOSCOPY AND BLADDER WASHOUT FOR RECURRENT URINARY TRACT INFECTIONS IN RENAL TRANSPLANT RECIPIENTS

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II1 Apr 2016MP32-14 CYSTOSCOPY AND BLADDER WASHOUT FOR RECURRENT URINARY TRACT INFECTIONS IN RENAL TRANSPLANT RECIPIENTS Andre Thomas, Benjamin Sherer, and Oyedolamu Olaitan Andre ThomasAndre Thomas More articles by this author , Benjamin ShererBenjamin Sherer More articles by this author , and Oyedolamu OlaitanOyedolamu Olaitan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1309AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Urinary tract infection (UTI) is the most common infection in renal transplant recipients (RTRs) and a major cause of morbidity; it is associated with the development of impaired allograft function, allograft loss and increased mortality. The aim of this study is to assess the effect of cystoscopy with bladder washout on the incidence of UTI in RTRs with recurrent complicated urinary tract infections. METHODS We offered cystoscopy with bladder washout to RTRs with recurrent UTIs (confirmed by positive urine culture) who had previously failed at least 2 courses of culture specific antibiotics. Bladder washout was performed via rigid cystourethroscopy under Monitored Anesthesia Care. The bladder was filled to capacity and emptied multiple times with a total of six liters of 0.9% sodium chloride irrigation fluid. We then evaluated for the number of UTIs in the six months pre and post bladder washout. RESULTS Thirty eight (29 female, 9 male) RTRs underwent cystoscopy with bladder washout performed by a single proceduralist between December 2013 and January of 2015. Mean age was 47.8 years. Mean time of bladder washout after renal transplantation was 3.65 years (range 9 months to 14 years). 17 patients (45%) were diabetic. All were on standard immunosuppression and PCP prophylaxis (with trimethoprim/sulfamethoxazole or diaminodiphenyl sulfone). None had a chronic ureteral stent in place. Post-procedurally, patients were followed with monthly urinalysis and culture. The number of UTI's in the 6 months prior to bladder washout (109) significantly decreased by 45% to 60 UTI's in the six months after bladder washout (p<0.02 via Wilcoxon signed rank test) CONCLUSIONS Cystoscopy with bladder washout appears to be effective method to decrease the frequency of UTI's in RTRs. Larger, controlled trials are necessary to confirm these findings. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e433 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Andre Thomas More articles by this author Benjamin Sherer More articles by this author Oyedolamu Olaitan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urinary ATP and visualization of intracellular bacteria: a superior diagnostic marker for recurrent UTI in renal transplant recipients?

Renal transplant recipients (RTR) are highly susceptible to urinary tract infections (UTIs) with over 50% of patients having at least one UTI within the first year. Yet it is generally acknowledged that there is considerable insensitivity and inaccuracy in routine urinalysis when screening for UTIs. Thus a large number of transplant patients with genuine urine infections may go undiagnosed and develop chronic recalcitrant infections, which can be associated with graft loss and morbidity. Given a recent study demonstrating ATP is released by urothelial cells in response to bacteria exposure, possibly acting at metabotropic P2Y receptors mediating a proinflammatory response, we have investigated alternative, and possibly more appropriate, urinalysis techniques in a cohort of RTRs.Mid-stream urine (MSU) samples were collected from 53 outpatient RTRs. Conventional leukocyte esterase and nitrite dipstick tests, and microscopic pyuria counts (in 1 μl), ATP concentration measurements, and identification of intracellular bacteria in shed urothelial cells, were performed on fresh unspun samples and compared to ‘gold-standard’ bacterial culture results.Of the 53 RTRs, 22% were deemed to have a UTI by ‘gold-standard’ conventional bacteria culture, whereas 87%, 8% and 4% showed evidence of UTIs according to leukocyte esterase dipstick, nitrite dipstick, and a combination of both dipsticks, respectively. Intracellular bacteria were visualized in shed urothelial cells of 44% of RTRs, however only 1 of the 23 RTRs (44%) was deemed to have a UTI by conventional bacteria culture. A significant association of the ‘gold-standard’ test with urinary ATP concentration combined with visualization of intracellular bacteria in shed urothelial cells was determined using the Fisher’s exact test.It is apparent that standard bedside tests for UTIs give variable results and that seemingly quiescent bacteria in urothelial cells are very common in RTRs and may represent a focus of subclinical infection. Furthermore, our results suggest urinary ATP concentration combined with detection of intracellular bacteria in shed urinary epithelial cells may be a sensitive means by which to detect ‘occult’ infection in RTRs.

Recurrent Urinary Tract Infections in Kidney Transplant Recipients

Urinary tract infections (UTIs) are the most common infectious complication after kidney transplantation (KT). Recurrent UTIs after KT can contribute to increased morbidity and may also be associated with graft loss and mortality. Though several risk factors like female gender, diabetes mellitus, presence of ureteric stents, native kidney disease with urological malformations and re-transplantation have been associated with recurrent UTIs after KT, vesicoureteric reflux appears to be a unique risk factor in this patient population. The emergence of drug-resistant pathogens as causative agents for post-transplant recurrent UTIs poses a significant therapeutic challenge. The use of pathogen-specific antibiotic therapy guided by culture and sensitivity data is warranted. The optimal duration of antimicrobial therapy for recurrent UTIs in renal transplant recipients remains uncertain.

Detection of renal scars by transplant renal ultrasounds and DMSA scans after urinary tract infections in paediatric renal transplant recipients

AimsTo study the clinical features and compare the accuracy of transplant renal ultrasound (TRUS) and dimercaptosuccinic acid (DMSA) scans in the detection of scars following urinary tract infection (UTI) in...

Urinary tract infection in renal transplant recipients

Urinary tract infection (UTI) is common in renal transplant recipients. Frequency of UTIs depend on many factors such as age, female gender, kidney function, co-morbidity, type and amount of immunosuppression, urological instrumentation and/or the follow-up period (short term or long term) after kidney transplantation. UTI may worsen graft and patient survival. A significant proportion of renal transplant recipients with UTIs may develop acute pyelonephritis (APN), which is an independent risk factor for deterioration of graft function. Renal transplant recipients with UTIs are often clinically asymptomatic as a consequence of immunosuppression. UTI, however, may progress to APN (particularly in the early post-transplant period), bacteraemia and the full blown picture of urosepsis. Strategies for long term prophylaxis and antimicrobial treatment of UTI in renal transplant recipients are discussed.

Gallium-67 scintigraphy in the detection of infected polycystic kidneys in renal transplant recipients.

Renal transplant recipients with underlying polycystic kidney disease (PKD) may present with recurrent urinary tract infection (UTI). This is often due to persistent infection in one or both of the native polycystic kidneys. It may be necessary to remove the infected kidney in order to remove the source of persistent infection. Gallium-67 scintigraphy was performed in 11 renal transplant recipients with underlying PKD. Positive studies were obtained in four recipients who had recurrent UTI. The scan also localized which of the kidneys (native or transplant) was the site of persistent infection. These four recipients subsequently had nephrectomy of the infected polycystic kidneys as suggested by the scan. Negative scans were obtained in seven recipients who did not have recurrent UTI. Gallium scintigraphy is a useful test for detecting and localizing the site of persistent UTI in renal transplant recipients with underlying PKD who present with recurrent UTI.

Urinary Tract Infections During Early Posttransplant Period in Adult kidney Allograft Recipients

Background: Urinary tract infections (UTIs) represent the most common cause of bacterial infection in renal allograft recipients. The purpose of this study was to evaluate UTI in renal transplant recipients at earlier post transplant period (first 3 months) and isolation of causative organism. Materials &amp; methods: We studied 31 patients (18 males and 13 females), aged 27 ± 8.8 years. UTIs occurring during the first three months were analyzed. During this period, all episodes of infection, transplant function, graft survival and patient survival were monitored. Results: Twenty two patients had suffered from different types of infection within first 3 months of transplantation, most of the infectious episodes occurred during hospital stay. Most of the infection occurred in urinary tract and most of the episodes of UTI were asymptomatic, presented with bacteriuria. Most of the isolated organisms were Gram negative E.Coli. Out of 51 episodes of bacterial infection, UTIs account for 49 episodes (96%) Patients’ age, sex and acute rejection episodes did not correlate with UTI. Patient who had prolonged urethral catheterization had suffered from significantly more number of UTI in comparison to short period of urethral catheterization (p=0.02).Similar incidence of UTI were observed in ureteric stented and non stented patients but non stented patients had suffered from significant number of urological complication (p&lt;0.02) . Antibiotic sensitivity pattern revealed that, all isolates were sensitive to ciprofloxacin, ceftriaxone and ceftazidime, ranged between, 67 to 100% and highly resistant to ampicillin, cotrimoxazole and cephradine. Conclusion : Short term renal graft function was not found to be affected by UTI occurrence. UTIs are common infectious complications in renal transplant recipients and often relapse and require hospitalization. Keyword: urinary tract infections (UTIs), renal transplantation, acute rejection episodes. DOI: http://dx.doi.org/10.3329/jom.v12i2.8416 JOM 2011; 12(2): 103-108