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Published on: April 12, 2021
Urinary Tract Infections in Kidney Transplant Recipients-Is There a Need for Antibiotic Stewardship?
Jens Strohaeker1, Victoria Aschke1, Alfred Koenigsrainer1
1Department of General, Visceral and Transplantation Surgery, University Hospital of Tuebingen, 72076 Tuebingen, Germany.
Abstract:
(1) Background: Urinary tract infections (UTI) are the most common infections after kidney transplantation. Given the risk of urosepsis and the potential threat to the graft, the threshold for treating UTI and asymptomatic bacteriuria with broad spectrum antibiotics is low. Historically fluoroquinolones were prescription favorites for patients that underwent kidney transplantation (KT). After the recent recommendation to avoid them in these patients, however, alternative treatment strategies need to be investigated (2) Methods: We retrospectively analyzed the charts of 207 consecutive adult kidney transplantations that were performed at the department of General, Visceral and Transplantation Surgery of the University Hospital of Tuebingen between January 2015 and August 2020. All charts were screened for the diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infections (UTI) and the patients' clinical characteristics and outcomes were evaluated. (3) Results: Of the 207 patients, 68 patients suffered from urinary tract infections. Patients who developed UTI had worse graft function at discharge (p = 0.024) and at the 12 months follow-up (p < 0.001). The most commonly prescribed antibiotics were Ciprofloxacin and Piperacillin/Tazobactam. To both, bacterial resistance was more common in the study cohort than in the control group. (4) Conclusions: Urinary tract infections appear to be linked to worse graft functions. Thus, prevention and treatment should be accompanied by antibiotic stewardship teams.
Insights
Urinary tract infections (UTI) in kidney transplant recipients are common and linked to worse graft function. Alternative antibiotic strategies are needed due to increasing bacterial resistance.
Area of Science:
- Nephrology
- Transplantation Surgery
- Infectious Diseases
Background:
- Urinary tract infections (UTI) are a frequent complication post-kidney transplantation (KT).
- High risk of urosepsis and graft compromise necessitates prompt UTI and asymptomatic bacteriuria (ASB) treatment.
- Fluoroquinolone use in KT patients is now discouraged, requiring investigation of alternative antimicrobial therapies.
Purpose of the Study:
- To evaluate the impact of UTI on kidney graft function.
- To identify common pathogens and antibiotic resistance patterns in KT recipients.
- To assess current treatment strategies for UTI and ASB in this population.
Main Methods:
- Retrospective analysis of 207 adult kidney transplant recipients from January 2015 to August 2020.
- Chart review to identify UTI and ASB diagnoses, treatments, and clinical outcomes.
- Evaluation of graft function at discharge and 12-month follow-up.
Main Results:
- 68 out of 207 patients developed UTI.
- UTI was associated with significantly worse graft function at discharge (p=0.024) and 12 months (p<0.001).
- Ciprofloxacin and Piperacillin/Tazobactam were common, with increased bacterial resistance observed.
Conclusions:
- UTI negatively impacts kidney transplant graft function.
- Antibiotic stewardship is crucial for managing UTI and ASB in KT patients.
- Further research into effective and resistance-minimizing treatment strategies is warranted.
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