Objective:Urinary tract infections(UTI) are a significant cause of morbidity after kidney transplantation. Screening for asymptomatic bacteruria(AB) has proven beneficial in certain adults like pregnant women; but it is poorly studied in the transplant population. We reviewed the clinical features and implications of AB one month after kidney transplantation.
Methods:A review of 176 adult kidney transplant patients (87(51%)male, 86(50%) living, mean age 47) from 2005-2012 was performed. Protocol urine cultures were taken at 1 month after transplantation for all patients, regardless of symptoms. Five patients were excluded with missing culture results. Bacteruria was defined as 105 CFUs of pathogenic organism per ml of voided urine specimen. All patients with + cultures were treated with appropriate antibiotics. Patients were analyzed according to culture positivity for associated factors and outcomes including hospitalizations, graft and patient survival.
Results:Among the 171 urine cultures, 41(24%) were positive for AB. Klebsiella penumoniae, E. coli and Enterococcus faecalis were the most common organisms, accounting for 34.1%, 26.8% and 22.0% of the isolates. Multi-resistant organisms accounted for 43.9% of the infections. Bacteruria was associated with deceased donor transplants (P=0.001) and female recipients (P=0.014). It was not associated (P=NS) with recipient age, race, native kidney disease, donor demographics, and regimen of induction or maintenance immunosupression, delayed graft function and duration of ureteric stent. Logistic regression confirms female sex (RR 2.6 95% CI 1.2-5.6, P<0.001) and deceased donor recipients (RR 7.7 95% CI 1.9-3.1, P=0.02) were independent predictors of AB at 30 days. Patients with AB were significantly more likely to be hospitalized subsequently for symptomatic UTI (RR 4.6 95% CI 2.1-9.9, P=0.001). However, there was no significant difference in 1-year patient (100% vs. 97%) and graft survival (95.1% vs. 95.4%) between the + and – culture group.
Conclusion:AB 30 days post transplant can be predicted in deceased donor and female recipients, reflecting functional and anatomical differences in voiding function. It is predictive of increased morbidity of subsequent hospitalization for symptomatic UTI and high risk groups may warrant targeted prophylaxis.
To cite this abstract in AMA style:Deng Z, Goh B, Raman L, Chen Z, Tai B, Goh A, Anantharaman V, Tiong H. Screening for Asymptomatic Bacteruria at One Month after Adult Kidney Transplantation: Clinical Factors and Implications [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/screening-for-asymptomatic-bacteruria-at-one-month-after-adult-kidney-transplantation-clinical-factors-and-implications/. Accessed November 29, 2020.
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