Predictive factors and management of urinary tract infections after kidney transplantation: a retrospective cohort study
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ORIGINAL ARTICLE
Predictive factors and management of urinary tract infections after kidney transplantation: a retrospective cohort study Toshihiro Shimizu1 · Toru Sugihara2 · Jun Kamei2 · Saki Takeshima1 · Yoshitaka Kinoshita1 · Taro Kubo1 · Takahiro Shinzato1 · Tetsuya Fujimura2 · Takashi Yagisawa1 Received: 27 March 2020 / Accepted: 15 September 2020 © Japanese Society of Nephrology 2020
Abstract Background Urinary tract infection (UTI) is one of the most common infectious complications in kidney transplant recipients. The aims of our study were to identify possible predictive factors for UTI and advocate for the management of UTI after kidney transplantation (KT). Methods Between January 2013 and December 2018, 182 adult patients with end-stage kidney disease who underwent KT were retrospectively analyzed. Patients who had urinary symptoms and positive urine culture were diagnosed with UTI. The types of urinary bacteria causing UTIs were also examined. Results UTIs occurred in forty-one patients (25.1%), and the median time to UTI onset (UTI-free survival) after KT was 189 days. The Cox hazard regression analysis showed that the predictive factors for UTI onset were as follows: posttransplant urinary catheterization, including indwelling urinary catheterization and clean intermittent catheterization; a maximum bladder capacity before KT of less than 150 ml; and a low serum albumin level at 1 month after KT. The most common causative agent was Escherichia coli (56.6%), followed by Enterococcus spp. (15.6%) and Klebsiella spp. Conclusions Kidney transplant recipients with prolonged postoperative malnutrition, posttransplant voiding dysfunction and/or urinary storage disorder had an increased risk of UTI. Bladder function tests, such as uroflowmetry, postvoid residual urine tests, and urodynamic tests, were needed to predict UTI. For patients with malnutrition, care should be taken to ensure sufficient calorie intake. Kidney transplant recipients who develop UTI should be treated as complicated UTI patients. Keywords Urinary tract infections · Kidney transplantation · Predictive factor · Bladder function tests · Malnutrition
Introduction Kidney transplantation (KT) is the most effective and beneficial type of renal replacement therapy for patients with stage five chronic kidney disease (CKD). It improves the overall survival rate and quality of life in patients compared to chronic dialysis [1]. Infections are common in patients receiving immunosuppressive treatment after transplantation. Potential complications of posttransplant urinary tract infection (UTI) include * Toshihiro Shimizu [email protected] 1
Department of Renal Surgery and Transplantation, Jichi Medical University, Yakushiji 3311‑1, Shimotsuke‑city, Tochigi 329‑0498, Japan
Department of Urology, Jichi Medical University, Shimotsuke‑city, Tochigi, Japan
2
bacteremia, allograft pyelonephritis, rejection, and increased morbidity and mortality [2]. Acute graft pyelonephritis can lead to worsened renal function, graft loss, or death,
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