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).