Risk Factors for Recurrent Urinary Tract Infections and Antimicrobial Resistant Organisms in Kidney Transplant Recipients

S. Greissman¹, A. Mattiazzi², J. Quinonez¹, M. Grady¹, R. Zukerman¹, A. Wawrzyniak³, M. Morris⁴, S. Anjan⁴, J. Simkins⁴, J. Camargo⁴, L. Abbo⁵

¹University of Miami Miller School of Medicine, Miami, FL, ²Department of Transplant Nephrology, University of Miami Miller School of Medicine, Miami, FL, ³Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, ⁴Department of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, ⁵Department of Infection Control and Prevention and Antimicrobial Stewardship, University of Miami Miller School of Medicine, Miami, FL

Meeting: 2019 American Transplant Congress

Abstract number: B229

Keywords: Immunosuppression, Infection, Kidney transplantation, Risk factors

Session Information

Session Name: Poster Session B: Kidney Infections

Session Type: Poster Session

Date: Sunday, June 2, 2019

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

*Purpose: Up to 20% of urinary tract infections (UTIs) in kidney transplant (KT) recipients are caused by multidrug-resistant organisms (MDROs). The risk factors for developing MDRO urinary tract infections (UTIs) and UTI recurrences are not fully understood; empiric therapy depends on local antibiotic resistance rates.

*Methods: This retrospective case-control study was performed to evaluate the factors associated with UTIs caused by MDROs up to 6 months post-KT. Donor and recipient characteristics, immunosuppression, stents, urine cultures, UTI recurrences, antimicrobial susceptibilities, and antibiotic regimens were reviewed between January 2015-December 2017 to compare post-KT patients who had UTIs vs those who did not.

*Results: Of a total of 840 adults who underwent KT during the study period, preliminary data from 214 patients (pts) were analyzed; 47 (22%) pts required hospitalization for a UTI. Among these pts, 15% had a single episode and 7% had 2 or more. Retransplant patients (21.3%, p=0.02) and immunosuppression with prednisone (25.5%, p=0.03) were significantly associated with having a UTI. The odds of a male having a UTI recurrence was 5.8 times greater than that of a female (95% CI 1.4-24.8, p=0.01). Neither peri-operative stents nor graft rejection within six months post-KT was significantly associated with recurrence. K. pneumoniae was the most common organism; 40% of the K. pneumoniae were resistant to fluoroquinolones and 35% were extended spectrum beta-lactamase producers (ESBLs) vs. 58.3% and 25% of the E.coli. 42.5% of the 47 UTIs were caused by MDROs: K. pneumoniae (N=10), E. coli (N=7), P. mirabilis (N=2), and C. freundii (N=1).

*Conclusions: Preliminary results from this study suggest that male gender is associated with recurrent UTIs. Interestingly, almost half of the UTIs in our cohort were caused by MDROs with limited therapeutic options. Identifying risk factors for developing MDROs has significant antimicrobial stewardship and infection prevention implications. With the global crisis in antimicrobial resistance, further preventive strategies need to be explored for transplant recipients.

To cite this abstract in AMA style:

Greissman S, Mattiazzi A, Quinonez J, Grady M, Zukerman R, Wawrzyniak A, Morris M, Anjan S, Simkins J, Camargo J, Abbo L. Risk Factors for Recurrent Urinary Tract Infections and Antimicrobial Resistant Organisms in Kidney Transplant Recipients [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-factors-for-recurrent-urinary-tract-infections-and-antimicrobial-resistant-organisms-in-kidney-transplant-recipients/. Accessed November 25, 2024.

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