Effects of recurrent urinary tract infections on graft and patient outcomes after kidney transplantation

Nicholas S. Britt, Jennifer C. Hagopian, Daniel C. Brennan, April A. Pottebaum, Carlos A.Q. Santos, Ara Gharabagi, Timothy A. Horwedel

Research output: Contribution to journalArticlepeer-review

Abstract

Background Urinary tract infections (UTIs) are common following kidney transplantation (KT); however, the influence of recurrent post-KT UTI (R-UTI) is not well-characterized. Methods We compared graft outcomes, patient outcomes and multidrug-resistance rates between patients with no UTI, nonrecurrent UTI (NR-UTI) (urine sample containing >10 5 bacterial colony-forming units/mL) and R-UTI (≥2 UTIs in any 6-month period or ≥3 UTIs in any 12-month period) post-KT in a retrospective cohort study (1999-2014) at Barnes-Jewish Hospital (St Louis, MO). All adult KT recipients were included and those experiencing mortality within 30 days of KT were excluded. Results Of 2469 recipients included, 1835 (74.3%) had no UTI, 465 (18.8%) had NR-UTI and 169 (6.8%) had R-UTI. R-UTI was associated with poorer graft survival compared with NR-UTI [hazard ratio (HR) 1.45; 95% confidence interval (CI) 1.23-1.83; P < 0.001) and no UTI (HR 2.11; 95% CI 2.02-3.80; P < 0.001). This relationship persisted after adjusting for confounding factors in Cox regression (HR 2.01; 95% CI 1.53-2.66; P < 0.001). There was no difference in patient survival between no UTI and NR-UTI (HR 1.21; 95% CI 0.91-1.63; P = 0.181); however, R-UTI was associated with poorer patient survival compared with nonrecurrent cases (HR 1.87; 95% CI 1.21-2.89; P = 0.005). R-UTI were more likely to be caused by multidrug-resistant Gram-negative organisms (risk ratio 1.49; 95% CI 1.31-1.70; P < 0.001). Conclusions R-UTIs were associated with poorer graft and patient outcomes, as well as increased multidrug-resistance compared with nonrecurrent cases.

Original languageEnglish (US)
Pages (from-to)1758-1766
Number of pages9
JournalNephrology Dialysis Transplantation
Volume32
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

Keywords

  • kidney transplant infection
  • kidney transplantation
  • multidrug-resistance
  • transplant infectious diseases
  • urinary tract infection

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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