Recurrent urinary tract infections in kidney transplant recipients

Urinary tract infection (UTI) constitutes the most frequent infection among kidney transplantation (KT) patients. The epidemiology and specific risk factors for recurrent UTI after KT have not been well studied. The aim of this work was to assess the incidence, pathogenic spectrum, and risk factors for recurrent post-KT UTI. This observational, cross-sectional study included all patients admitted to our transplantation department with a diagnosis of post-KT UTI from January 2010 to December 2011. Recurring post-KT UTI was defined as ≥ 2 UTIs in 6 months or ≥ 3 UTIs in 12 months. Factors associated with recurrent post-KT UTI were assessed using logistic regression analysis. The 154 patients were diagnosed with 315 episodes of post-KT UTI (28.6%), with recurrent post-KT UTI among 72% of cases. Most recurrent UTIs (73.6%) occurred during the first year after KT. Klebsiella species was the most common isolated pathogen (53.2%), being a serious problem for multidrug-resistance (odds ratio [OR], 13; 95% confidence interval [CI] 5.9-28.6; P < .001). The presence of nosocomial infection (OR, 2.8; 95% CI, 1.4-5.4; P < .003) and multidrug-resistant bacteria (OR, 3.8; 95% CI, 2-7.2; P < .001) emerged as independent predictors of recurrent post-KT UTI. KT recipient demographics and characteristics, factors related to KT and urologic complications, did not differ significantly between patients with versus without recurrent post-KT UTI. In conclusion, in a unit where recurrent post-KT UTI incidence was 72% and Klebsiella species was the prevailing uropathogen, nosocomial infection and multidrug-resistant bacteria appeared to be independent predictive factors for recurrent post-KT UTI.