title: Community-acquired urinary tract infection in kidney transplantation: risk factors for bacteremia and recurrent infection.
abstract: OBJECTIVE
  Urinary tract infection (UTI) is the most common type of infectious complication among kidney transplant patients. However, the antibiotic susceptibility of causative microorganisms and risk factors for concomitant bacteremia and recurrent infection are rarely discussed.
  
  
  METHODS
  This was a retrospective cohort review of kidney transplant recipients who had received follow-up in the past 10 years at the Chung-Shan Medical University (Taichung, Taiwan). Only community-acquired and symptomatic UTIs were included in this study.
  
  
  RESULTS
  During the 53 ± 22 months of follow-up, 99 patients developed 167 episodes of UTI. Forty-two (25%) episodes had concomitant bacteremia. Escherichia coli was the most common causative microorganism, and strains with resistance to multiple commonly used empirical antibiotics began to emerge. The independent risk factors for UTI with concomitant bacteremia in multivariate analysis were immunosuppression with tacrolimus (adjusted odds ratio [AOR] 3.17; 95% confidence interval [CI] 1.29-7.75; P = 0.011) and baseline serum creatinine level >1.3 mg/dL before first UTI (AOR 2.55; 95% CI 1.02-6.36; P = 0.045). However, there were no factors that were significantly associated with recurrent infection.
  
  
  CONCLUSIONS
  From this study, we found that E coli tends to have resistance to commonly used empirical antibiotics in this modern era and that patients who use the immunosuppressant tacrolimus and have baseline serum creatinine level >1.3 mg/dL before their first UTI have a tendency to suffer from concomitant bacteremia and even sepsis.
authors.affiliation: The Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Sheng-Wen
authors.initials: SW
authors.lastname: Wu
authors.forename: Keh-Sen
authors.initials: KS
authors.lastname: Liu
authors.forename: Chih-Kuang
authors.initials: CK
authors.lastname: Lin
authors.forename: Tung-Wei
authors.initials: TW
authors.lastname: Hung
authors.forename: Hui-Ching
authors.initials: HC
authors.lastname: Tsai
authors.forename: Horng-Rong
authors.initials: HR
authors.lastname: Chang
authors.forename: Jong-Da
authors.initials: JD
authors.lastname: Lian
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000209:etiology*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000209:etiology*