Urinary Tract Infections After Kidney Transplantation: A Risk Factor Analysis of 417 Patients

BACKGROUND The aim of this study was to evaluate the number of urinary tract infections (UTI) that occur after kidney transplantation (KT) and to identify possible risk factors for development of a UTI. MATERIAL AND METHODS We retrospectively analyzed all KTs performed between January 2012 and December 2013 in the Erasmus University Medical Center, Rotterdam. UTI was scored if: (1) a patient had a urine culture with no more than 2 species of microorganisms, (2) at least 1 of which was a bacterium of ≥10^5 CFU/mL, (3) which was treated with antibiotics, and (4) which occurred within 3 months after KT. RESULTS A total of 417 patients were transplanted from January 2012 until December 2013. A UTI developed in 115 (28%), after a median of 13 days from transplantation (range: 3-82 days). The most common causative agent was Escherichia coli, followed by Enterococcus faecalis, Enterococcus faecium, and Klebsiella pneumoniae. The variables that were independently related to a UTI were female gender (OR 3.58, 95%CI 2.16-5.91), recipients age >60 y (OR 2.12, 95%CI 1.28-3.48), percutaneous nephrostomy placements (OR 6.29, 95%CI 3.35-11.85), and surgical re-interventions (OR 2.12, 95%CI 1.04-4.32). Mean glomerular filtration rate was significantly lower in the group of patients with a UTI at 3, 6, 9, and 12 months postoperatively compared to those patients who did not have a UTI. CONCLUSIONS We conclude that a UTI after KT is a common problem. We identified independent risk factors for the development of a UTI. UTI is associated with a GFR decrease postoperatively.