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Published on: April 13, 2021
Multiple Drug Resistant Urinary Tract Infection in Kidney Transplant Recipients: A Retrospective Cohort Study
Rashid Bin Hamid1, Shanila Javaid1, Muhammad Tassaduq Khan1
1Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan.
Abstract:
Urinary tract infection (UTI) is the most common infectious disease in post-kidney transplantation patients. The objective of the study was to investigate the prevalence, impact and risk factors of multiple drug resistant (MDR) UTI in kidney transplant recipients. This retrospective cohort study recruited 72 kidney transplant recipients between March 2017 and February 2018. Urine cultures performed during the 1st year of posttransplantation with reference to clinical data were evaluated. Predesigned questionnaire was used to collect data regarding demographic, transplant related, and microbiological information. Multivariate analysis was performed to ascertain risk factors of MDR UTI. Out of 72 patients, 28 (38.9%) had culture guided clinical UTI. Overall, 59 UTI episodes were noted throughout the duration of this study. Eschericia coli were found to be the most frequent uropathogen of UTI among kidney transplant recipients (n = 32, 54.2%). MDR bacteria were responsible for 27.1% (n = 16) of the post-transplantation UTI episodes among patients, with E. coli (n = 9, 56.3%) being the predominant bacterial pathogen. Most of the MDR strains of E. coli (n = 7, 77.8%) were extended spectrum beta-lactamase positive. Female gender (P <0.001), prolonged Foley's catheterization (P = 0.002), coexisting diabetes mellitus (DM) (P <0.001) and induction of anti-thymocyte globulin (ATG) therapy (P <0.001) were independently associated with high risk of MDR UTI. The allograft rejection was found to be significantly higher in patients of posttransplantation UTI with MDR uropathogen (P = 0.009). In conclusion, E. coli were the most prominent uropathogen of UTI with and without MDR pathogen in the present study. Female gender, prolonged Foley's catheterization, coexisting DM, and induction of ATG therapy were the risk factors independently associated with MDR UTI in kidney transplant recipients. MDR organisms were significantly associated with allograft rejection.
Insights
Multiple drug-resistant urinary tract infections (UTIs) are common in kidney transplant patients. Female gender, prolonged catheterization, diabetes, and anti-thymocyte globulin therapy increase MDR UTI risk and allograft rejection.
Area of Science:
- Nephrology
- Infectious Diseases
- Transplantation Immunology
Background:
- Urinary tract infections (UTIs) are a significant complication in kidney transplant recipients.
- Multiple drug-resistant (MDR) organisms pose a growing threat in this vulnerable population.
Purpose of the Study:
- To determine the prevalence, impact, and risk factors of MDR UTIs in kidney transplant recipients.
- To identify specific pathogens and their resistance patterns in post-transplant UTIs.
Main Methods:
- Retrospective cohort study of 72 kidney transplant recipients over one year.
- Analysis of urine cultures, clinical data, and demographic/transplant-related information.
- Multivariate analysis to identify independent risk factors for MDR UTI.
Main Results:
- 28% of patients experienced culture-confirmed UTI, with 59 episodes overall.
- Escherichia coli was the most common uropathogen (54.2%), including MDR strains (27.1%).
- Female gender, prolonged Foley catheterization, diabetes mellitus, and anti-thymocyte globulin therapy were significant risk factors for MDR UTI.
Conclusions:
- E. coli is the predominant uropathogen in kidney transplant recipients, with a notable proportion exhibiting MDR.
- Specific patient and treatment factors are independently associated with an increased risk of MDR UTI.
- MDR UTIs in kidney transplant recipients are significantly linked to higher rates of allograft rejection.
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