title: Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: a single-center report of 1166 kidney allograft recipients.
abstract: BACKGROUND
  Urinary tract infection (UTI) is a frequent, serious complication in kidney allograft recipients.
  
  
  METHODS
  We reviewed the records of 1166 kidney allograft recipients who received their allografts at our institution between January 2005 and December 2010 and determined the incidence of UTI during the first 3 months after transplantation (early UTI). We used Cox proportional hazards models to determine the risk factors for early UTI and whether early UTI was an independent risk factor for subsequent bacteremia or acute cellular rejection (ACR).
  
  
  RESULTS
  UTI, defined as 10 or more bacterial colony-forming units/mL urine, developed in 247 (21%) of the 1166 recipients. Independent risk factors for the first episode of UTI were female gender (hazard ratio [HR], 2.9; 95% confidence intervals [CI], 2.2-3.7; P<0.001), prolonged use of Foley catheter (HR, 3.9; 95% CI, 2.8-5.4; P <0.001), ureteral stent (HR, 1.4; 95% CI, 1.1-1.8; P=0.01), age (HR, 1.1; 95% CI, 1.0-1.2; P=0.03), and delayed graft function (HR, 1.4; 95% CI, 1.0-1.9; P=0.06). Trimethoprim/sulfamethoxazole prophylaxis was associated with a reduced risk of UTI (HR, 0.6; 95% CI, 0.3-0.9; P=0.02). UTI was an independent risk factor for subsequent bacteremia (HR, 2.4; 95% CI, 1.2-4.8; P=0.01). Untreated UTI, but not treated UTI, was associated with an increased risk of ACR (HR, 2.8; 95% CI, 1.3-6.2; P=0.01).
  
  
  CONCLUSIONS
  Female gender, prolonged use of Foley catheter, ureteral stent, age, and delayed graft function are independent risk factors for early UTI. UTI is independently associated with the development of bacteremia, and untreated UTI is associated with subsequent ACR.
authors.affiliation: 1 Division of Nephrology and Hypertension, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. 2 Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. 3 Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California-Davis, Davis, CA. 4 The Rogosin Institute, New York, NY. 5 Transplantation-Oncology Infectious Diseases Program, Department of Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. 6 Division of Transplant Surgery, Department of Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY. 7 Address correspondence to: Thangamani Muthukumar, M.D., Division of Nephrology and Hypertension, Department of Medicine, and Department of Transplantation Medicine, New York Presbyterian Hospital-Weill Cornell Medical College, 525 East 68th Street, Box 3, New York, NY.
authors.forename: John R
authors.initials: JR
authors.lastname: Lee
authors.forename: Heejung
authors.initials: H
authors.lastname: Bang
authors.forename: Darshana
authors.initials: D
authors.lastname: Dadhania
authors.forename: Choli
authors.initials: C
authors.lastname: Hartono
authors.forename: Meredith J
authors.initials: MJ
authors.lastname: Aull
authors.forename: Michael
authors.initials: M
authors.lastname: Satlin
authors.forename: Phyllis
authors.initials: P
authors.lastname: August
authors.forename: Manikkam
authors.initials: M
authors.lastname: Suthanthiran
authors.forename: Thangamani
authors.initials: T
authors.lastname: Muthukumar
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology*; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000453:epidemiology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000382:microbiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data; D014184:Transplantation, Homologous; D014513:Ureter; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology
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