Introduction. The gut microbiota has recently been identified as a risk factor for development of infectious complications like bacteremia; herein, we evaluated the relationship between the gut microbiota and gram-negative urinary tract infections (UTI) in kidney transplant recipients.

Methods. We prospectively collected serial fecal specimens from 71 kidney transplant recipients and profiled their gut microbiota using 16S rRNA deep sequencing of the V4-V5 hypervariable region. Thirteen of the 71 subjects developed gram-negative UTI in the first 3 months of transplantation (UTI Cohort) and 58 subjects did not (No UTI Cohort). We compared all available fecal specimens corresponding to positive gram-negative urine cultures from the UTI Group (N=11) to all available fecal available specimens corresponding to negative gram-negative urine cultures from the No UTI Group (N=135).

Results. Shannon diversity index was not significantly different between the specimens from the UTI Cohort and those from the No UTI Cohort (mean 3.7±0.6 vs. 3.7±0.6, P=0.79, Wilcoxon rank sum test). However, the fecal abundance of Proteobacteria (the phylum which encompasses gram negative UTIs) was significantly higher in the specimens from the UTI Cohort than those from the No UTI Cohort (mean 7% vs. 1%, P=0.036) with elevated fecal Proteobacteria abundance preceding gram negative UTIs. Predicted metagenomics using PICRUSt suggested distinct functional pathways increased in the UTI Cohort, including multi-drug resistant genes. Conclusions. We report a novel relationship between the gut microbiota and gram-negative UTI in kidney transplant recipients, which supports future studies targeting the gut microbiota to prevent and/or treat UTIs.

CITATION INFORMATION: Lee J, Mcgruder M, Zhang L, Dadhania D, Thangamani M, Ling L, Taur Y, Pamer E, Suthanthiran M. Gut Microbiota-Urinary Tract Infection Axis in Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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