Urinary Tract Infection After Kidney Transplantation: Some Centers are Doing Better Than Others

Area of Science:

• Nephrology
• Transplantation Surgery
• Infectious Disease Epidemiology

Background:

• Urinary tract infection (UTI) is a common complication post-kidney transplant, leading to increased morbidity and healthcare costs.
• Significant variability in UTI rates among kidney transplant centers is suspected but not well-quantified.

Purpose of the Study:

• To investigate the variation in 30-day UTI incidence across kidney transplant centers.
• To identify patient-specific and center-specific factors associated with post-transplant UTIs.

Main Methods:

• Analysis of kidney transplant recipients from the NSQIP Transplant pilot database (3/2017-7/2020).
• Utilized multivariable and hierarchical logistic regression to identify UTI risk factors and assess center outlier status.

Main Results:

• Overall 30-day UTI incidence was 6.1% across 5128 recipients at 25 centers, with unadjusted rates ranging from 0% to 12.9%.
• Independent risk factors for UTI included ureteral stent use, longer urinary catheter duration, female gender, and recipient age.
• These factors explained 17% of the center variation; three centers remained outliers after adjustment.

Conclusions:

• Wide variation in early UTI incidence exists among US kidney transplant centers.
• Known risk factors do not fully account for the observed center-level differences in UTI rates.
• Further research and inter-center collaboration are needed to reduce post-transplant UTIs.