Results
A total of 102 kidney transplant recipients were analyzed in this study. Forty-nine were women (48%) and 53 (52%) were men, with a mean age of 37,6± 12,2 years. The etiologic distribution of underlying primary kidney disease was as follows: primary glomerulonephritis (29/28.4%), autosomal dominant polycystic kidney disease (ADPKD) (6/5.8%), diabetic nephropathy (9/8.8%), hypertensive nephropathy (12/11.7%), others (13/12.7%), and unknown etiology (33/ 32.3%). Five patients had undergone second kidney transplantation. Seventy- seven (75.5%) patients were on hemodialysis, 4 (3.9%) were on peritoneal dialysis (PD), 7 patients were treated consecutively with both HD and PD (6.8%) before the transplantation and 14 (13.7%) patients underwent preemptive transplantation.
21 patients experienced at least one UTI over the study period and the incidence rate for a UTI was 20.5% across the whole cohort. A total of 67 UTI episodes were analyzed in the UTI group and the mean number of UTIs per person in this group was 3,19±1,8 [Range 1–7]. The median time to first UTI attack was calculated as 62 days [range 11-205 days] after transplantation. Presentations of 36 UTI episodes were LUTI, 23 were CUTI and 8 were ABU. Three patients (14,2%) experienced UTI related bacteremia. Forty-seven episodes (70,1%) were seen within the first six months of transplantation. The demographics and baseline characteristics of patients with and without UTI are shown in Table 1. In univariate analysis, age, dialysis vintage, foley catheter dwell time and presence of urologic complications were significantly different between the groups [Table 1]. In multivariate analysis age (p=0.009; 95% Confidence Interval [CI]: 1.014-1.105), longer indwelling urinary catheter stay time (p=0.027; 95% Confidence Interval [CI]: 1.010-1.174) and urologic complications (p=0.032; 95% Confidence Interval [CI]: 0.094-0.896) were found as the main risk factors for UTI development in first year of transplantation.
The most common pathogen was Escherichia coli, isolated in 52 episodes (77,6%), followed by Klebsiella spp. in 10 (14,9%) whereas fungal species were found as causative agents in 3 (4,4 %) UTI episodes. In three UTI episodes, two different microorganisms were isolated. In total, 71 microorganisms were isolated in all patients. After excluding fungal causes, 43 out of 68 bacterial microorganisms (63.2%) were caused by ESBL producing microorganisms. Details on UTI attacks, including causative agents, class of antibiotic used and treatment duration are summarized in Table 2.
Fifteen patients (71.4%) (7 male/8 female) had at least one ESBL positive microorganism isolated as the causative agent of their UTI. Twelve patients (57.1%) had recurrent UTI attacks while 6 of them (50%) had recurrent UTI with MDROs. When we examined UTI episodes in detail, it was noteworthy to discover that male patients were more often infected with MDRO and had more recurrent UTIs when compared to female patients. The male recipients also had more CUTI at presentation compared with female recipients (Table 3).
In the analysis of fungal UTI episodes, all of them were resistant species and they were not accepted colonization even if they occurred while the patients still had ureteral stents. All in three patients required treatment with voriconazole or anidulafungin and all were treated successfully.
There was no impact of UTI even in recurrent patients, on short-term graft functions regarding creatinine levels.