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Recurrence of urinary tract infections and development of urinary-specific antibiogram for kidney transplant
Ghazwa B Korayem1, Tirdad T Zangeneh2, Kathryn R Matthias3
1Department of Pharmaceutical Practices, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia; Department of Pharmacy Practice and Science, University of Arizona, Tucson, AZ, USA; Banner - University Medical Center Tucson, Tucson, AZ, USA.
Objectives:
Urinary tract infection (UTI) recurrence and antimicrobial resistance remain a common problem in kidney transplant recipients. Whilst the use of annual institutional antibiograms may help guide appropriate empirical antibiotic selection, these non-disease specific antibiograms do not always account for patient-specific risk factors or disease-specific resistance patterns. This study determined the frequency of UTI recurrence during the first year after kidney transplantation as well as differences in antimicrobial susceptibility between an institutional antibiogram and the disease-specific antibiogram for patients following kidney transplantation.
Methods:
In this study, adult patients with at least one UTI during an inpatient admission within 1 year post kidney transplantation were evaluated. A disease-specific antibiogram for UTIs in kidney transplant recipients was prepared based on culture results and was compared with the annual institutional antibiograms.
Results:
Of 299 kidney transplants performed during the study period, 66 subjects meet the study inclusion criteria, of whom 47% had two or more UTIs within the first year after kidney transplant. In comparison with the institutional antibiogram, Escherichia coli isolated from urine samples from kidney transplant recipients were significantly more resistant to trimethoprim/sulfamethoxazole, ceftriaxone, cefepime, ciprofloxacin and gentamicin (P<0.0001).
Conclusions:
Multiple UTIs are common in kidney transplant recipients during the first year post-transplantation. E. coli urinary isolates were significantly more resistant to multiple antibiotic drug classes in this patient population compared with the general hospital population. Antimicrobial stewardship programmes at transplant centres should consider producing disease-specific antibiograms specifically for transplant recipients to improve empirical antibiotic selection guidance.
Insights
Recurrent urinary tract infections (UTIs) are common in kidney transplant recipients. Escherichia coli in these patients show higher resistance to antibiotics than in the general population, necessitating disease-specific antibiograms.
Area of Science:
- Nephrology
- Transplant Surgery
- Infectious Diseases
Background:
- Urinary tract infections (UTIs) and antimicrobial resistance are significant challenges for kidney transplant recipients.
- Standard institutional antibiograms may not accurately reflect resistance patterns in this vulnerable patient group.
- Patient-specific risk factors and disease-specific resistance are crucial for effective UTI management post-transplantation.
Purpose of the Study:
- To determine the frequency of UTI recurrence within the first year after kidney transplantation.
- To compare antimicrobial susceptibility patterns between institutional and disease-specific antibiograms for kidney transplant recipients.
- To identify differences in antibiotic resistance for UTIs in kidney transplant recipients.
Main Methods:
- Adult patients with at least one UTI within one year post-kidney transplant were evaluated.
- A disease-specific antibiogram was created using urine culture results from kidney transplant recipients.
- This disease-specific antibiogram was compared against the institution's annual antibiogram.
Main Results:
- Of 66 eligible kidney transplant recipients, 47% experienced two or more UTIs in the first year.
- Escherichia coli isolates from these patients demonstrated significantly higher resistance to trimethoprim/sulfamethoxazole, ceftriaxone, cefepime, ciprofloxacin, and gentamicin compared to institutional data (P<0.0001).
Conclusions:
- Multiple UTIs are frequent in the first year post-kidney transplant.
- E. coli exhibits increased resistance to multiple antibiotic classes in kidney transplant recipients versus the general hospital population.
- Transplant centers should develop disease-specific antibiograms for recipients to enhance empirical antibiotic selection.
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