title: Extended-spectrum-beta-lactamase producing bacteria related urinary tract infection in renal transplant recipients and effect on allograft function.
abstract: BACKGROUND
  Urinary tract infection (UTI) is a well-recognized early complication in renal transplant recipients (RTR) and can have significant bearing on their outcome. The recent rise in incidence of extended spectrum beta lactamase (ESBL) producing bacteria causing UTI among RTR poses new and significant challenges in terms of management and outcome. Our aim is to analyze the effect of ESBL producing bacteria causing UTI in these patients and its impact on allograft function.
  
  
  METHODS
  We reviewed the medical records of 147 RTR who were followed at a tertiary care hospital affiliated transplant center between January 2007 and May 2013 and noted five RTR who developed episodes of ESBL producing bacteria related UTI during follow up. Multiple patient characteristics including demographics, immunosuppression, recurrences, allograft function and outcome were analyzed.
  
  
  RESULTS
  Five patients (3.4%) out of 147 had ESBL producing bacteria related UTI. We found all patients to be above 60 years of age, with three out of five being females, and all five patients had diabetes mellitus. We identified a total of 37 episodes of UTI among these five patients during this period. Two of these patients had elevated creatinine values during the episodes of UTI and three of them developed bacteremia. Of the five patients, four of them had a favorable outcome except for one patient who developed persistent allograft dysfunction.
  
  
  CONCLUSIONS
  RTR are at a higher risk for developing ESBL producing bacteria associated UTI. Early diagnosis along with appropriate and judicious use of antibiotics will ensure long term success in allograft and patient outcome.
authors.affiliation: Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Poornima
authors.initials: P
authors.lastname: Ramadas
authors.affiliation: Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Prejith P
authors.initials: PP
authors.lastname: Rajendran
authors.affiliation: Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Prathik
authors.initials: P
authors.lastname: Krishnan
authors.affiliation: Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Asha
authors.initials: A
authors.lastname: Alex
authors.affiliation: Department of Surgery, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Eric
authors.initials: E
authors.lastname: Siskind
authors.affiliation: Department of Nephrology, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Aditya
authors.initials: A
authors.lastname: Kadiyala
authors.affiliation: Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Vivek
authors.initials: V
authors.lastname: Jayaschandran
authors.affiliation: Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Amit
authors.initials: A
authors.lastname: Basu
authors.affiliation: Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Madhu
authors.initials: M
authors.lastname: Bhaskaran
authors.affiliation: Transplant Program, North Shore University Hospital, Manhasset, New York, United States of America.
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
mesh_terms: D000368:Aged; D064591:Allografts / Q000503:physiopathology*; D001419:Bacteria / Q000378:metabolism*; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D066027:Transplant Recipients; D014552:Urinary Tract Infections / Q000382:microbiology*; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D003404:Creatinine; D001618:beta-Lactamases