Clinical Measures to Reduce Early Urinary Tract Infections Following Kidney Transplantation: A Single Center Experience.
Nephrology and Hypertension, Allegheny General Hospital, Pittsburgh, PA.
Meeting: 2016 American Transplant Congress
Abstract number: D247
Keywords: Infection, Kidney transplantation, Urinalysis
Session Information
Session Name: Poster Session D: Poster Session II: Kidney Complications-Other
Session Type: Poster Session
Date: Tuesday, June 14, 2016
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Urinary Tract infection (UTI) following kidney transplantation (KTx) is associated with increased morbidity. We implemented simple clinical measures in an attempt to reduce UTI incidence within 90 days of KTx at our center.
Among 74 patients who had KTx from 6/15/2013 to 4/15/2014, seventeen (23%) developed UTI in the first 90 days after KTx. The time to first UTI was 24.8±16 days, 88% needed hospitalization and 94% developed acute kidney injury (AKI).
In an attempt to minimize the incidence and morbidity of UTI, clinical practice policies were implemented which included the following: urinary Foley catheter placement by surgeon in the operating room at the time of KTx, minimize use of ureteral stents, urinary Foley catheter removal on post-op day 3 with post void residual (PVR) urine volume measurement and urine analysis with reflex cultures. Urology clearance was added as a requisite to wait-list dialysis-dependent anuric diabetic men over 55 year old. After 3 months of implementing these policies, UTI incidence was re-valuated.
Among 81 KTx done between 7/1/14 and 6/30/15, only 6 (7.4%) developed early UTI which was a statistically and clinically significant reduction (p=0.007).
Demographics and details of UTI are shown in table 1.
| Pre-intervention UTI | Post-intervention UTI | |
| DEMOGRAPHICS | ||
| Number of KTx | 74 | 81 |
| Incidence of UTI (%) | 17 (23%) | 6 (7.4%)* |
| Age (y) | 58±12 | 63±8 |
| Gender (M/F) | 13/4 | 4/2 |
| Baseline creatinine (mg/dl) | 1.6±0.7 | 1.5±0.8 |
| KTx type (living/deceased) | 3/14 | 3/3 |
| Previous KTx (%) | 6 (35%) | 0 |
| Diabetics (%) | 8 (47%) | 3 (50%) |
| Induction (Thymo/Basiliximab) | 14/2 | 4/2 |
| BPH history (%) | 12 (71%) | 1 (17%)** |
| Prior UTI (%) | 5 (29%) | 1 (17%) |
| Acute rejection in 1st 3 mo. (%) | 4 (24%) | 1 (17%) |
| UTI DETAILS | ||
| Time to first UTI (days) | 25±16 | 33±29 |
| UTI requiring hospitalization (%) | 15(88%) | 3 (50%)*** |
| AKI with UTI (%) | 16 (94%) | 4 (67%) |
| Rise in creatinine with UTI (mg/dl) | 1.3±1.8 | 1.8±2.7 |
| Tacrolimus level at time of UTI (ng/ml) | 13±3 | 13±5 |
| Ureteral stent removal (post op day #) | 29±24 | 19±5 |
| PVR >200 ml on discharge (%) | 10 (59%) | 2 (33%) |
| Urinary Foley on discharge (%) | 9 (56%) | 2 (33%) |
| p-value; *=0.007; **=0.02; ***=0.05 | ||
Our findings demonstrate the effectiveness of simple clinical measures in reducing post-KTx UTI.
CITATION INFORMATION: Chopra B, Ko T, Webster C, Sheyman J, Arumgarajah A, Katragadda V, Marcus R, Sureshkumar K. Clinical Measures to Reduce Early Urinary Tract Infections Following Kidney Transplantation: A Single Center Experience. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Chopra B, Ko T, Webster C, Sheyman J, Arumgarajah A, Katragadda V, Marcus R, Sureshkumar K. Clinical Measures to Reduce Early Urinary Tract Infections Following Kidney Transplantation: A Single Center Experience. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/clinical-measures-to-reduce-early-urinary-tract-infections-following-kidney-transplantation-a-single-center-experience/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress