Abstract: PUB512
Urinary Tract Infections in Kidney Transplant Recipients: A Single-Centre Experience
Session Information
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Evans, Nicholas, St George's University of London, London, London, United Kingdom
- Montero, Rosa M., St George's University Hospitals NHS Foundation Trust, London, London, United Kingdom
Background
Urinary tract infections(UTIs) occur in 25% of kidney transplant recipients (KTR) within one year post-transplant(PTx) accounting for 45% of infective complications. Few reports are on the timeframe of recurrent UTIs >1yrs PTx. Recurrent UTIs are associated with bacteraemias, impaired allograft function, allograft loss, acute T-cell mediated rejection causing increased morbidity and mortality. We looked to determine the frequency, organisms and influencing factors for UTIs in our cohort.
Methods
A cross-sectional retrospective observational study of all KTR at our centre with a UTI from April 2022- April 2023. Clinical data was extracted from electronic patient records and microbiology electronic system. Recurrent UTIs was defined: 2 episodes of symptomatic acute bacterial cystitis in 6 months or 3 episodes within a year. Data on organism and sensitivities, immunosuppression(IS) regimens, deprivation scores 1 most deprived, 10 least deprived) were collected. Paired t-tests and ANOVA were used to perform statistical analysis with a p<0.05 significant level.
Results
167 of 516 KTR had a UTI between 2022-2023 with a total of 294 UTIs in 167 KTR. 58 Male,109 Female. Median age 59yrs(range 18-92yrs). 24% White, 20% Black, 16% Asian, 1% Chinese, 8% Other, 31% unknown. Number of UTIs in KTR: x1 65% (109), x2 20.4%(34), x3 6.6%(11), x4 3%(5), x5 0.6%(1), x6 1.2%(2), x7 0.6%(1), x8 0.6%(1), x10 1.8%(3). UTIs median 31 weeks (range 9 days to 16.4 years) PTx. Deprivation scores were insignificant (p=0.08). 20 different organisms were grown 54% Escherichia coli, 15.5% Enterococcus, 8.8% Klebsiella pneumonia, 7.7% staphylococcus organisms, 4.7% proteus, 3% pseudomonas, 6.3% combination of different organisms. Tacrolimus based IS regimens had more UTIs (p<0.05) compared to non-tacrolimus regimens. 24% UTIs were fully sensitive with 60% of all UTIs resistant to Amoxicillin, 16% other antibiotic resistant micro-organisms.
Conclusion
UTIs continue to be problematic up to 16yrs PTx. 32% of KTR had UTI between 2022-2023 with 35% of KTR having >2. Consistent with previous results females had more UTI and were predominantly gram-negative. Tacrolimus based regimens increased risk of UTIs. Up to 10 recurrent UTIs occurred PTx. Deprivation scores did not influence UTI occurence. We recommend reviewing IS regimens in KTR with recurrent UTIs to avoid allograft dysfunction, morbidity and mortality.