Open Access Highly Accessed Research article

Prospective study of urinary tract infection surveillance after kidney transplantation

Roberto Rivera-Sanchez1, Dolores Delgado-Ochoa2, Rocio R Flores-Paz1, Elvia E García-Jiménez1, Ramon Espinosa-Hernández3, Andres A Bazan-Borges3 and Myriam Arriaga-Alba14*

Author Affiliations

1 Microbiology Research Laboratory, Hospital Juárez de México, Avenida Instituto Politécnico Nacional, México, D.F. 07760, México

2 Histocompatibility Research Laboratory, Hospital Juárez de México, Avenida Instituto Politécnico Nacional, México, D.F. 07760, México

3 Renal Transplant Surgery Division. Hospital Juárez de México, Avenida Instituto Politécnico Nacional, México, D.F. 07760, México

4 Hospital Juarez De Mexico. Avenida Instituto Politécnico Nacional No. 5160, DF., 07760, México

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BMC Infectious Diseases 2010, 10:245  doi:10.1186/1471-2334-10-245

Published: 19 August 2010

Abstract

Background

Urinary tract infection (UTI) remains one of the main complications after kidney transplantation and it has serious consequences.

Methods

Fifty-two patients with kidney transplantation were evaluated for UTI at 3-145 days (mean 40.0 days) after surgery.. Forty-two received a graft from a live donor and 10 from a deceased donor. There were 22 female and 30 male patients, aged 11-47 years. Microscopic examinations, leukocyte esterase stick, and urinary culture were performed every third day and weekly after hospitalization. A positive culture was consider when patients presented bacterial counts up to 105 counts.

Results

UTI developed in 19/52 (37%) patients at 3-75 days (mean 19.5 days after transplantation. Recurrent infection was observed in 7/52 (13.4%) patients at days 17-65. UTI was more frequent in patients who received deceased grafts compared with live grafts (7/10, 70% vs. 12/42, 28%; p < 0.007). Female patients were more susceptible than male (11/22, 50% vs. 8/22, 36.35%; p < 0.042). Five-year survival rate was 94.5% (49/52 patients). Kidney Graft exit update is 47/52 (90.2%), and there were no significant differences between graft rejection and UTI (p = 0.2518). Isolated bacteria were Escherichia coli (31.5%), Candida albicans (21.0%) and Enterococcus spp. (10.5%), followed by Pseudomonas aeruginosa, Klebsiella pneumoniae, Morganella morganii, Enterobacter cloacae and Micrococcus spp. Secondary infections were produced by (7/19, 36.8%). Enterococcus spp. (57%), E. coli (28%) and Micrococcus spp. (14.2%). Antibiotic resistance was 22% for ciprofloxacin and 33% for ampicillin. Therapeutic alternatives were aztreonam, trimethoprim-sulfamethoxazole, netilmicin and fosfomycin.

Conclusions

Surveillance of UTI for the first 3 months is a good option for improving quality of life of kidney transplantation patients and the exit of graft function especially for female patients and those receiving deceased grafts. Antibiograms provided a good therapeutic alternative to patients who presented with UTIs after receiving a kidney allograft.