Institutional protocol adherence in the incidence of recurrent urinary tract infection after kidney transplantation. (December 2020)

• Record Type: Journal Article
• Authors: Freire, Maristela P.; Martinho, Lorena; Mendes, Clara V.; Spadão, Fernanda; De Paula, Flavio Jota; Nahas, William C.; David-Neto, Elias; Pierrotti, Ligia C.
• Is Part Of: Journal of global antimicrobial resistance. Volume 23(2020)
• Page Start: 352
• Page End: 358
• Publication Date: 2020-12
• Subjects: Multidrug resistance -- Stewardship -- Treatment -- Urinary tract infection -- Kidney transplantation -- Diabetic nephropathy; Drug resistance -- Periodicals; Drug resistance -- Periodicals; Drug resistance; Periodicals; 616.9041
• DOI: 10.1016/j.jgar.2020.10.013
• Languages: English
• ISSNs: 2213-7165

Abstract

Highlights: Antibiotic treatment of UTI for short periods may increase the risk of recurrent UTI (rUTI) after kidney transplantation. Increased frequency of rUTI among kidney transplant recipients with infection by multidrug-resistant (MDR) bacteria. This may be associated with other characteristics that lead these patients to have MDR bacterial infections. Kidney transplant recipients who develop UTI in the first 6 months after transplantation are at risk for rUTI. Rapid initiation of antimicrobial therapy in kidney transplant recipients with UTI reduces the risk of recurrent infection. Abstract: Objectives: Recurrent urinary tract infections (rUTIs) occur frequently after kidney transplantation (KT), however their optimal management remains undefined. This study aimed to identify risk factors for rUTI and to validate a protocol for UTI and rUTI treatment after KT. Methods: This retrospective cohort study involved patients undergoing KT between January 2013 and July 2016. Patients were followed-up from day of KT until graft loss, death or end of follow-up (31 December 2018). We analysed all episodes of symptomatic UTI. The main outcome measure was rUTI after KT. Analysis was done per episode in a multilevel approach; patient features were considered in the distal level and UTI features in the proximal level. Univariate and multivariate analyses were performed by Cox regression. A propensity score was used to adjust the risk of patients with carbapenem-resistant Enterobacteriaceae. Results: During the study period, 787 patients underwent KT, of whom 152 (19.3%) developed 356 UTI episodes. The most common micro-organisms were Escherichia coli (165/356; 46.3%) and Klebsiella pneumoniae (101/356; 28.4%). Multidrug-resistant micro-organisms were isolated in 161 UTIs (45.2%). Risk factors for rUTI were diabetic nephropathy as the cause of end-stage renal disease ( P = 0.02), UTI in first 180 days after KT ( P = 0.04), anatomic alteration of the urinary tract at UTI diagnosis ( P = 0.004) and length of time to effective therapy ( P = 0.002); UTI treatment duration according to institutional protocol ( P = 0.04) was the only protective factor identified. Conclusion: Appropriate therapy duration has an impact on rUTI prevention after KT.