Background: Urinary tract infections (UTIs) are the most common infection after kidney transplant (KTx) resulting in significant morbidity and mortality. The reported incidence of UTIs after KTx varies widely due to risk factors such as pre-transplant time on dialysis, donor type, urinary catheterization duration, re-transplantation, prophylactic antibiotics, and net immunosuppression. Increased antibiotic use and rising rates of multi-drug resistant organisms (MDRO) further complicate management. This study aims to define the incidence of MDRO after KTx and evaluate associated risk factors.

Methods: A single-center, retrospective review of renal transplant recipients from April 2015 to April 2016 was conducted. Patients were stratified based on the presence of UTI within the first year post-transplant. Incidence of MDRO UTIs (resistance to >2 classes of antibiotic) was defined by urine culture and sensitivity reports. Prophylactic antibiotic use (PPX), serum creatinine (SCr), patient survival (PS), graft survival (GS), and biopsy-proven acute rejection (BPAR) were also documented for each group.

Results: A total of 141 patients were analyzed. Patients were primarily male recipients (65%) of kidney transplant alone (92%) from deceased donors (89%) with 87% receiving depleting induction. Mean duration of dialysis prior to transplant was three years. Average duration of foley catheterization was four days. Thirty-five patients (23%) developed UTIs, represented by 71 cultures. UTIs developed an average of 96 days post-transplant. The most common organisms were K. pneumoniae (32%), E.coli (17%), E.cloacae (11%), E. faecalis (10%), and E. faecium (7%) with the majority reported as MDRO (66%). Compared to those without UTI, patients who developed UTI were mostly female (68 vs. 25%) with a higher prevalence of deceased donor transplants (80 vs. 55%) and a greater mean duration of dialysis prior to transplant (5.3 vs. 3.8 years). Patients with UTIs had a numerically higher rate of BPAR (14.7 vs. 8.1%); PS and GS were similar between groups (91 vs. 96%; 97 vs. 98%). Formal statistical analysis is ongoing.

Conclusions: UTIs among our patient population were more common among female recipients of deceased donor transplants and were primarily caused by MDROs. The rate of BPAR was higher among patients with UTI, although further analysis is needed to determine significance.

CITATION INFORMATION: Hooker D., Gutierrez K., Foster K., Dodson A. Multi-Drug Resistant Urinary Tract Infections Following Renal Transplant: Risk Factors and Patient Outcomes Am J Transplant. 2017;17 (suppl 3).

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