title: Urinary tract infections in renal transplant recipients.
abstract: BACKGROUND
  Urinary tract infections (UTIs) are most common infections in renal transplant recipients and are considered a potential risk factor for poorer graft outcomes.
  
  
  OBJECTIVE
  To evaluate incidence, clinical manifestations, microbiology, risk factors for UTIs, and the influence of UTIs on long-term renal graft function.
  
  
  METHODS
  We analyzed urine cultures with reference to clinical data of patients who received a renal transplantation from January to December 2009 with a 12-month follow-up.
  
  
  RESULTS
  The 1170 urine cultures were correlated with clinical data from 89 renal transplant recipients, including 58.4% males and on overall mean age of 48±14 years. The 151 episodes in 49 patients consisted of asymptomatic bacteriuria (65%, n=98); lower UTIs (13%, n=19); and upper UTIs (22%, n=34), as well as five cases of bacteremia. Nearly 48% of UTIs were diagnosed during the first month posttransplantation. The most frequently isolated uropathogens were Enterococcus faecium (33%, n=24) and Escherichia coli (31%, n=23). Beginning from the second month, most frequently found bacterium in urine cultures was E coli (65% n=51). Risk factors for posttransplant UTIs were female gender and a history of an acute rejection episode and/or a cytomegalovirus (CMV) infection. All patients with vesicoureteral reflux of strictures at the ureterovesical junction suffered recurrent UTIs (n=7). The evolution of renal graft function did not differ significantly between patients with versus without UTIs.
  
  
  CONCLUSIONS
  UTIs a frequent problem after kidney transplantation most commonly exist as asymptomatic bacteriuria. E coli and E faecium are ther predominant pathogens. Exposure to intensified immunosuppression due to acute rejection episodes or CMV infections represents a risk factor for UTIs. Vesicoureteral reflux or strictures at the ureterovesical junction are risk factors for recurrent UTIs. UTIs did not impair 1-year graft function.
authors: Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland. igolebiewska@gumed.edu.pl
authors: J
authors: J
authors: Gołębiewska
authors: A
authors: A
authors: Dębska-Ślizień
authors: J
authors: J
authors: Komarnicka
authors: A
authors: A
authors: Samet
authors: B
authors: B
authors: Rutkowski
mesh_terms: D000328:Adult; D001437:Bacteriuria / Q000209:etiology; D015331:Cohort Studies; D016984:Enterococcus faecium; D004927:Escherichia coli Infections / Q000209:etiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000209:etiology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology*