Background:

Urinary tract infection (UTI) is the most common complication that kidney transplant recipients encounter in the first year of transplantation. Earlier studies have identified several risk factors for UTI, but few have been examined in the context of current changes in the practice of transplantation and in the context of multivariable analysis for confounders.

Methods:

In this retrospective cohort study, 1166 renal transplant recipients were reviewed for the development of UTI during the first three months of transplantation at our institution during 1/2005 to 12/2010. We collected demographical characteristics and determined the risk factors associated with UTI using a multivariable Cox regression. We also reviewed the impact of UTI on bacteremia episodes within the first three months of transplantation and acute cellular rejection (ACR) within the first year.

Results:

UTI occurred in 247 of the 1166 transplant recipients (21.2%) using a definition of 10^5 cfu/mL. Independent risk factors for UTI included: female gender (HR:2.9,P<0.001), prolonged use of Foley catheter (HR:3.9,P<0.001), ureteral stent placement (HR:1.4,P=0.014), age (HR:1.11,P=0.034), and delayed graft function (HR:1.4,P=0.06). Trimethoprim/sulfamethoxazole prophylaxis was found to be a protective factor (HR:0.6, P=0.01). UTI was identified to be a risk factor for development of bacteremia by multivariable Cox regression (HR: 2.6, P=0.006). Untreated UTI (HR: 2.8, P=0.01) but not treated UTI was a risk factor for development of ACR.

Conclusion:

We identified that female gender, prolonged use of Foley catheter, ureteral stent placement, age, delayed graft function, and lack of trimethoprim/sulfamethoxazole prophylaxis were independent risk factors for the development of UTI in the first 3 months of kidney transplantation. UTI is an independent risk factor for the development of bacteremia and intriguingly untreated UTI appears to be a risk factor for ACR.

« Back to 2013 American Transplant Congress