Recurrent UTIs After Renal Transplants

[okarol]

Recurrent UTIs After Renal Transplants
John Schieszer
October 11 2010

BOSTON—Older age, female gender, and delayed graft function are among the independent risk factors for recurrent urinary tract infections (UTIs) among renal transplant recipients, according to a new prospective study presented at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy. The risk for future UTIs also is increased if the first UTI is caused by a multidrug-resistant pathogen.

The risk for recurrent UTIs increased by 2% for each year of age, researchers reported. Female patients had a 1.8 times increased risk compared with male patients. Delayed graft function, hepatitis C virus infection, and polycystic kidney disease as a cause of transplantation each was independently associated with a twofold-increased risk of recurrent UTIs. If the first UTI was caused by a multidrug-resistant pathogen, the risk was increased 5.6 fold.

“These findings are important because they point to ways of reducing the rates of recurrent urinary tract infections in renal transplant patients,” said lead investigator Carlos Cervera, MD, Associate Professor of Medicine in the Division of Infectious Diseases at the University of Barcelona in Spain. “You have take steps to lower risks. That may mean removing the urinary catheter as soon as possible and trying to reduce antibiotic use as much as possible.”

Another preventive strategy may be to discharge renal transplant patients from the hospital as soon as possible, Dr. Cervera said.

UTIs are the most common infectious complication in renal transplant recipients, he said, adding that most UTIs occur within 12 months of transplantation. Renal transplant recipients have higher rates of UTIs, hospitalizations, and deaths due to gram-negative septicemia associated with pyelonephritis compared to patients on renal transplant waiting lists.

Dr. Cervera and his colleagues studied 473 renal transplant recipients (272 male) with a mean age of 51 years. Patients who experienced two or more UTI episodes were considered to have recurrent UTIs. Multidrug-resistant organisms were those that were resistant to three or more types of antibiotics or produced extended-spectrum beta-lactamases.

All patients received cefazolin immediately prior to surgery and trimethoprim/sulfamethoxazole (TMP/SMX) three times during the first six months post-transplantation for Pneumocystis jirovecii pneumonia prophylaxis. Patients with proven allergy to sulfamides received inhaled pentamidine. The mean follow-up for the study was 625 days.

The investigators identified 291 UTI episodes in 151 patients, which translated into a cumulative incidence of 32% and an incidence rate of 9.06 episodes per 10,000 transplant days.  Among these 151 patients, 37 (13%) had positive blood cultures. Recurrent UTIs occurred in 65 patients (14%). Escherichia coli were responsible for 43% of the episodes, followed by Klebsiella species (17%), Pseudomonas aeruginosa (14%), and enterococci (12%). Multidrug-resistant isolates represented 33% of the strains, and 44 patients (9%) were diagnosed as having their first UTI with a multidrug resistant pathogen.

http://www.renalandurologynews.com/recurrent-utis-after-renal-transplants/article/180801/

[monrein]

They've kept me on Bactrim once daily ever since transplant.

[MooseMom]

I know that Bactrim is sort of the go to antibiotic for UTI's, but what if you're allergic to it?

I seem to remember reading somewhere that before you are transplanted, they do some sort of sensitivity test on you to see if you're allergic to Bactrim.  Is that true?

[paris]

I take Septra 3 times a week.  (sulfamethoxazole/trimethoprim)  Same as Bactrim.   I was never tested prior to transplant.  I had a UTI concern during week 2.  It ended up being a contaminated sample.  But, you can see why it is such a concern.  It is a direct line to the new kidney.  It is one of the biggest concerns regarding rejection those first couple of months.  I will be on it at least 6 months. They will re-evaluate then.

[okarol]

Jenna is on one Bactrim twice a week prophylacticly.
If she gets a UTI they usually give her Cipro.
We were told that because she has to self-cath 4 times a day she will always be at risk for infection.

[MooseMom]

I've just emailed my transplant coordinator with some information.  I had a UTI back in 2002, my first such infection, and I was successfully treated with Bactrim.  In Oct 2003, I developed a dental abscess and was treated with clindamycin (Cleocin).  Coincidentally, a week later, I was treated for a UTI with Bactrim and pyridium (for pain), so for a period of a couple of days, I was being treated with three different meds.  I developed a rather spectacular case of hives.  Afterwards, I'd always assumed I was allergic to Bactrim, but I've always had a question about this in my mind.  It occurred to me after reading several threads on IHD that this might be a rather important piece of information, so I emailed my transplant coordinator with this history and with the belief that I really don't know what exactly caused the hives.

I just don't do antibiotics very well, so I think it might be important to see what I CAN tolerate before I get my new kidney!   Like that's just around the corner...

[paris]

I can't imagine how deligent Jenna has to be.  That would seem like such a hard thing to deal with every single day.  So much for her to handle.  I don't ever want to complain, because she has lived with so much since she was a teenager.   You've been an amazing support for her, Okarol.  (and for all of us)   Hope Jenna is holding steady.  We want her to keep this kidney as long as she can.