title: Impact of urinary tract infections on short-term kidney graft outcome.
abstract: Urinary tract infections (UTIs) are frequent after renal transplantation, but their impact on short-term graft outcome is not well established. All kidney transplants performed between July 2003 and December 2010 were investigated to evaluate the impact of UTI on graft function at 1 year after transplantation. Of 867 patients who received a kidney transplant, 184 (21%) developed at least one episode of UTI, at a median of 18 days after transplantation. The prevalence of acute graft pyelonephritis (AGP) was 15%. The most frequent pathogens identified were Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa, 37% of which were considered to be multidrug-resistant strains. Thirty-eight patients (4%) lost their grafts, 225 patients (26%) had graft function impairment and the 1-year mortality rate was 3%; however, no patient died as a consequence of a UTI. Surgical re-intervention and the development of at least one episode of AGP were independently associated with 1-year graft function impairment. Moreover, the development of at least one episode of AGP was associated with graft loss at 1 year. Patients with AGP caused by a resistant strain had graft function impairment more frequently, although this difference did not reach statistical significance (53% vs. 36%, p 0.07). Neither asymptomatic bacteriuria nor acute uncomplicated UTI were associated with graft function impairment in multivariate analysis. To conclude, UTIs are frequent in kidney transplant recipients, especially in the early post-transplantation period. Although AGP was significantly associated with kidney graft function impairment and 1-year post-transplantation graft loss, lower UTIs did not affect graft function.
authors.affiliation: Infectious Diseases Department, Spain. Electronic address: mbodro@clinic.ub.es.
authors.forename: M
authors.initials: M
authors.lastname: Bodro
authors.affiliation: Infectious Diseases Department, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Sanclemente
authors.affiliation: Infectious Diseases Department, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Lipperheide
authors.affiliation: Infectious Diseases Department, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Allali
authors.affiliation: Microbiology Department, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Marco
authors.affiliation: Microbiology Department, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Renal Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Cofan
authors.affiliation: Renal Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: M J
authors.initials: MJ
authors.lastname: Ricart
authors.affiliation: Renal Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Esforzado
authors.affiliation: Renal Transplant Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Oppenheimer
authors.affiliation: Infectious Diseases Department, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Moreno
authors.affiliation: Infectious Diseases Department, Spain. Electronic address: ccervera@clinic.ub.es.
authors.forename: C
authors.initials: C
authors.lastname: Cervera
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000145:classification / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011704:Pyelonephritis / Q000453:epidemiology* / Q000382:microbiology / Q000503:physiopathology; D012189:Retrospective Studies; D012307:Risk Factors; D014552:Urinary Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
keywords: Acute graft pyelonephritis; graft survival; impaired graft function; kidney transplantation; urinary tract infections