COMPLICATIONS - INFECTIONS

M. Nowicki¹, M. Wajdlich¹, M. Mascidlo¹, Z. Zbrog², I. Kurnatowska^1
1Dept. Nephrology, Hypertension And Kidney Transplantation, Medical University of Lodz, Lodz/POLAND, ²Nephrology And Transplantation, Kopernik Regional Hospital, Lodz/POLAND

Body: Introduction. Bacterial infections are common after kidney transplantation (KTx). Their rate and etiology are influenced by multiple factors related mainly to immunosuppression, surgical interventions and hospitalization. Interestingly the problem of bacterial urinary tract infections (UTI) including their changing etiology, recurrence, and resistance to treatment has rarely been thoroughly investigated after kidney transplantation. In this study we compared the incidence, recurrence and etiology of bacterial urinary tract infections in the early and late period after kidney transplantation. Material and Methods: Prospective cohort study of deceased donor kidney transplant patients from two satellite transplant centers who underwent KTx in years 2007-2009. All patients received standard triple immunosuppressive therapy (prednisone, MMF/MPA, Tc).
Results. In the analyzed period nearly 30% of the patients in our cohort were diagnosed with bacterial UTI (mean age 48.9 ± 12.5 yrs, mean estimated glomerular filtration rate 50.6 ± 20.3 ml/min). Total number of UTI episodes was 217. Similar to the general population the prevalence of UTI was higher in women than in men (47.5 vs 20.7 %). 29.3% of all bacterial UTI was found in the first 6 months after KTx with 80% of them in the first 3 months. The most frequent pathogens in that period were: Enterococci faecalis (40%), including Enterococcus faecium HLAR and Enterococcus feacalis HLAR , Escherichia coli (15.4%), Klebsiella pneumoniae (13.8%), Staphylococcus epidermidis (10.8%), Staphylococcus saprophyticus (6.2%), Staphylococcus haemolyticus (4.6%), and Staphylococcus aureus (3%). UTI diagnosed later than 6 months after KTx were mostly caused by: Escherichia coli (51.3%), Enterocci faecalis (10%), Klebsiella pneumoniae (9.5%), Staphylococcus epidermidis (4.4%), Staphylococcus saprophyticus (1.3%), Staphylococcus haemolyticus (0.6%), and Staphylococcus aureus (1.9%). Recurrent UTI were found in only 18% of all affected patients. Prolonged hospitalization was the most significant risk factor for both early and late UTI. Conclusions: The incidence of bacterial urinary tract infections is high in both early and late period after KTx. Most UTI in the first 6 months after KTx are nosocomial as they are mainly caused by Enterococci and other hospital-acquired pathogens. Despite persistent immunosupression and regular outpatient clinic visits the etiology of bacterial UTI after 6 months post KTx resembles that observed in the general population.

Disclosure: All authors have declared no conflicts of interest.