Urinary Tract Infections in Renal Transplant Recipients

ABSTRACT

BACKGROUND: To evaluate urinary tract infections (UTI) in renal transplant recipients in setting where TMP-SMX resistance is quite common. MATERIALS AND METHODS: All patients underwent renal transplantation at Samsung Medical Center from January 1998 to August 2002 were included with the completion of 2 year-follow-up. TMP- SMX was prophylactically administered during 12 months after renal transplantation. Their medical records and microbiologic data were reviewed, retrospectively. RESULTS: A total of 336 patients were enrolled (male to female ratio, 191145; mean age, 39+/-10 years). 146 episodes of UTI were observed in 104 patients (31.0%) within 2 years after renal transplantation. 52 episodes (35.6%) developed during post-transplantation 30 days, and 87 episodes (59.6%) within post-transplantation 6 months. There was no difference in the incidence of UTI with regard to the type of immunosuppressants (P=0.371) or graft rejections (P=0.291). Among the isolated strains, Escherichia coli (E. coli) (51.4%) was the most common, followed by Enterococcus species (12.3%), Pseudomonas species (6.8%), Enterobacter species (6.1%), Coagulase-negative staphylococci (5.5%), and Klebsiella species (5.5%). Among 75 E. coli isolates, rates of resistance to TMP-SMX, ciprofloxacin, ampicillin-sulbactam and ceftriaxone were 62.7%, 34.7%, 33.3%, and 1.0%, respectively. There was no difference in mortality rate related with the occurrence of UTI (P= 0.754). CONCLUSION: Despite high prevalence of TMP-SMX resistance, post-transplantation UTI is usually mild and does not seem to predispose to increase graft rejection or patient mortality. Nevertheless, because most common episodes of UTI occur within 1 or 6 months of transplantation, further studies are warranted to evaluate if additional preventive strategies during early period are needed.