Background: Urinary tract infections (UTI) are the most common infection among kidney transplant (KT) patients and are associated with significant morbidity and mortality. Most studies have focused on patients with early UTI within the first few months of KT when indwelling catheters and stents might pose as risk factors. There is inadequate data on the risk factors, microbiology and antibiotic resistance patterns among patients with late recurrent UTIs.

Methods: Recurrent UTIs were defined as ≥2 UTIs in 6 months or ≥3 UTIs in 12 months. A UTI was diagnosed based upon the presence of pyuria defined as >5 WBCs/high-power field and a urine culture of >100,000 colonies/mL. All consecutive patients who presented to the transplant clinic for follow-up over the study period of six months were enrolled. Patients were assessed for known published risk factors based upon chart review.

Results: A total of 20 patients were diagnosed with recurrent UTIs based upon prior history. The mean age for all patients was 53±16 years with a median time to first UTI of 149 days (range 12-690 days). A majority of patients were female (16/20; 80%) and diabetic (12/20; 60%). Among the 16 women, 13 (81%) were post-menopausal. Of the remaining 3 females, two had type 1 diabetes with neurogenic bladder and one had post-coital UTIs. Three (out of 4) males had an identifiable risk factor – two with prostate enlargement and one with neurogenic bladder. A total of 140 UTIs were documented with a median of 13 infections per person (range 2-19). A majority of infections were due to Escherichia coli (30/140; 21%) and Klebsiella spp. (40/140; 29%) with the remainder being largely due to Enterococcus spp. (28/140; 20%). Multidrug resistance was a rapidly emerging problem with 11% of the gram negative organisms being ESBL and 41% of the gram positive organisms being vancomycin resistant.

Conclusions: In this preliminary analysis of an ongoing study of a cohort of kidney transplant patients with late recurrent UTIs we report that a majority of infections can be explained by known risk factors. Especial attention to the treatable risk factors for eg, neurogenic bladder, post-menopausal atrophic vaginitis, better diabetes control, prostate hypertrophy might prevent development of multidrug resistance. Further studies to develop appropriate algorithms for the management of KT patients with recurrent UTIs are critically needed.

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