Patients-Methods
Patients who underwent renal transplantation between October 2011 and July 2018 were included in the study. Patients younger than 18 years of age and patients with primary non-functioning kidney were excluded from the study. Urinary tract infections that developed in the first year after transplantation were examined retrospectively. Patients received a triple-drug immunosuppressive regimen typically consisting of calcineurin inhibitors (tacrolimus or cyclosporine), mycophenolate mofetil, and prednisone. Basiliximab was used as standard induction, while anti-thymocyte globulin was given to patients at high immunological risk. Corticosteroids were progressively tapered to 5 mg/day over 3 months.
Antibiotic prophylaxis with single dose cefuroxime at a dose of 2 g was used in all patients before surgery. Ofloxacillin was administered after transplantation for 7 days. Trimethoprim/sulfamethoxazole was started for Pneumocystis Jiroveci prophylaxis was started on 7th day post transplant and continued for 6 months at a dose of 400/80 mg/day. The ureteral stents placed during the transplant operation are removed at 6-8 weeks after transplantation, in the absence of active UTIs. Post-transplant urologic complications were defined as need for intermittent catheterization, bladder atony, need for surgical reconstruction of the urinary tract including ureteral necrosis, and ureteral and/or urethral strictures. [11]
UTI was defined as the presence of urine culture positivity with more than 105 colony-forming units (CFU) of bacteria per mL with UTIs symptoms. A positive urine culture without any clinical symptoms was considered as asymptomatic bacteriuria (ABU). According to patients’ clinical presentations, UTI attacks were divided into three groups: Lower UTI (LUTI), Complicated UTI (CUTI) and ABU (1). All patients with UTIs with ureteral stent were treated. Recurrent UTI was defined as ≥ 3 UTIs in any 12-month period or ≥2 UTIs in any 6-month period, irrespective of the causative organism [12].
Extended spectrum beta-lactamase producing organisms (Escherichia coli, Klebsiella pneumoniae, Enterobacter spp., or Citrobacter spp.), Acinetobacter baumanii, methicillin-resistant Staphylococcus aureus, Enterococcus fecium, and Pseudomonas aeruginosa were considered as MDROs [13].
Patients were compared regarding the presence of at least one episode of UTI. This study was approved by the institutional review board (IRB approval number: 09.2017.429).