Surveillance for UTI Improves Quality of Life for Kidney Transplant Patients

Urinary tract infection (UTI) remains one of the main complications after kidney transplantation and it has serious consequences. Rivera-Sanchez, et al. (2010) evaluated 52 patients with kidney transplantation for UTI at three to 145 days (mean 40.0 days) after surgery. Forty-two received a graft from a live donor and 10 from a deceased donor. There were 22 female and 30 male patients, aged 11 to 47 years. Microscopic examinations, leukocyte esterase stick, and urinary culture were performed every third day and weekly after hospitalization. A positive culture was consider when patients presented. Their research was published in BMC Infectious Diseases.

The researchers report that UTI developed in 19/52 (37 percent) patients at three to 75 days (mean 19.5 days after transplantation. Recurrent infection was observed in 7/52 (13.4 percent) patients at days 17 to 65. UTI was more frequent in patients who received deceased grafts compared with live grafts (7/10, 70 percent vs. 12/42, 28 percent; p < 0.007). Female patients were more susceptible than male (11/22, 50 percent vs. 8/22, 36.35 percent; p < 0.042). Five-year survival rate was 94.5 percent (49/52 patients). Kidney graft exit update was 47/52 (90.2 percent), and there were no significant differences between graft rejection and UTI (p = 0.2518).

Isolated bacteria were Escherichia coli (31.5 percent), Candida albicans (21.0 percent) and Enterococcus spp. (10.5 percent), followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Morganella morganii, Enterobacter cloacae and Micrococcus spp. Secondary infections were produced by (7/19, 36.8 percent). Enterococcus spp. (57 percent), E. coli (28 percent) and Micrococcus spp. (14.2 percent). Antibiotic resistance was 22 percent for ciprofloxacin and 33 percent for ampicillin. Therapeutic alternatives were aztreonam, trimethoprim-sulfamethoxazole, netilmicin and fosfomycin.

Sanchez, et al. (2010) concluded that surveillance of UTI for the first three months is a good option for improving quality of life of kidney transplantation patients and the exit of graft function especially for female patients and those receiving deceased grafts. Antibiograms provided a good therapeutic alternative to patients who presented with UTIs after receiving a kidney allograft.

Reference: Rivera-Sanchez R, Delgado-Ochoa D, Espinoza-Hernandez R, Flores-Paz R, Garcia-Jimenez E, Bazan-Burges A and Arriaga-Alba M. Prospective study of urinary tract infection surveillance after kidney transplantation. BMC Infectious Diseases 2010, 10:245doi:10.1186/1471-2334-10-245