Top

Published in:

01-10-2019 | Kidney Transplantation | Review

Updates on urinary tract infections in kidney transplantation

Authors: Marco Fiorentino, Francesco Pesce, Antonio Schena, Simona Simone, Giuseppe Castellano, Loreto Gesualdo

Published in: Journal of Nephrology | Issue 5/2019

Abstract

Urinary tract infection (UTI) represents the most common infection after kidney transplantation; it is associated with an increased risk for acute kidney rejection and impaired graft function in the early post-transplant period. Kidney transplant recipients with UTIs are often clinically asymptomatic due to the immunosuppressive therapy; however, asymptomatic bacteriuria may progress to acute pyelonephritis, bacteremia and urosepsis, particularly in the early post-transplant period, that are independent risk factors for short and long-term graft and patient survival. This article reviews the definitions, incidence, risk factors and the management of UTI in kidney transplant recipients; furthermore, the main controversial and still unanswered questions, regarding the causes of recurrent UTIs, adequate use of antibiotics to avoid antibiotic resistance, dosing and timing for prophylaxis and treatment of symptomatic infections, are also discussed. The emerging definition of urinary microbiota introduces new concepts in understanding the complexity of the disease and might represent the future target for therapeutic interventions.

Karuthu S, Blumberg EA (2012) Common infections in kidney transplant recipients. Clin J Am Soc Nephrol 7:2058–2070. https://doi.org/10.2215/CJN.04410512 CrossRefPubMed

Rice JC, Safdar N (2009) Urinary tract infections in solid organ transplant recipients. Am J Transplant 9(Suppl 4):S267–S272. https://doi.org/10.1111/j.1600-6143.2009.02919.x CrossRefPubMed

Alangaden GJ, Thyagarajan R, Gruber SA et al (2006) Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant 20:401–409. https://doi.org/10.1111/j.1399-0012.2006.00519.x CrossRefPubMed

Bodro M, Sabe N, Tubau F et al (2013) Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients. Transplantation 96:843–849. https://doi.org/10.1097/TP.0b013e3182a049fd CrossRefPubMed

Castaneda DA, Leon K, Martin R et al (2013) Urinary tract infection and kidney transplantation: a review of diagnosis, causes, and current clinical approach. Transplant Proc 45:1590–1592. https://doi.org/10.1016/j.transproceed.2013.01.014 CrossRefPubMed

de CR Ferreira, Cristelli F, Paula MP et al (2017) Infectious complications as the leading cause of death after kidney transplantation: analysis of more than 10,000 transplants from a single center. J Nephrol 30:601–606. https://doi.org/10.1007/s40620-017-0379-9 CrossRef

Ariza-Heredia EJ, Beam EN, Lesnick TG et al (2014) Impact of urinary tract infection on allograft function after kidney transplantation. Clin Transplant 28:683–690. https://doi.org/10.1111/ctr.12366 CrossRefPubMed

Lorenz EC, Cosio FG (2010) The impact of urinary tract infections in renal transplant recipients. Kidney Int 78:719–721. https://doi.org/10.1038/ki.2010.219 CrossRefPubMed

Grabe M, Bjerklund-Johansen TE, Botto H et al (2015) Guidelines on urological infections. European Association of Urology, London

10.

Lee JR, Bang H, Dadhania D et al (2013) Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: a single-center report of 1166 kidney allograft recipients. Transplantation 96:732–738. https://doi.org/10.1097/TP.0b013e3182a04997 CrossRefPubMed

11.

Ariza-Heredia EJ, Beam EN, Lesnick TG et al (2013) Urinary tract infections in kidney transplant recipients: role of gender, urologic abnormalities, and antimicrobial prophylaxis. Ann Transplant 18:195–204. https://doi.org/10.12659/AOT.883901 CrossRefPubMed

12.

Veroux M, Giuffrida G, Corona D et al (2008) Infective complications in renal allograft recipients: epidemiology and outcome. Transplant Proc 40:1873–1876. https://doi.org/10.1016/j.transproceed.2008.05.065 CrossRefPubMed

13.

Saemann M, Horl WH (2008) Urinary tract infection in renal transplant recipients. Eur J Clin Investig 38 (Suppl 2):58–65. https://doi.org/10.1111/j.1365-2362.2008.02014.x CrossRef

14.

Pelle G, Vimont S, Levy PP et al (2007) Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 7:899–907. https://doi.org/10.1111/j.1600-6143.2006.01700.x CrossRefPubMed

15.

Senger SS, Arslan H, Azap OK et al (2007) Urinary tract infections in renal transplant recipients. Transplant Proc 39:1016–1017. https://doi.org/10.1016/j.transproceed.2007.02.060 CrossRefPubMed

16.

Abbott KC, Swanson SJ, Richter ER et al (2004) Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis 44:353–362CrossRefPubMed

17.

Valera B, Gentil MA, Cabello V et al (2006) Epidemiology of urinary infections in renal transplant recipients. Transplant Proc 38:2414–2415. https://doi.org/10.1016/j.transproceed.2006.08.018 CrossRefPubMed

18.

Dantas SRPE, Kuboyama RH, Mazzali M, Moretti ML (2006) Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect 63:117–123. https://doi.org/10.1016/j.jhin.2005.10.018 CrossRefPubMed

19.

Silva C, Afonso N, Macario F et al (2013) Recurrent urinary tract infections in kidney transplant recipients. Transplant Proc 45:1092–1095. https://doi.org/10.1016/j.transproceed.2013.02.019 CrossRefPubMed

20.

Korth J, Kukalla J, Rath P-M et al (2017) Increased resistance of gram-negative urinary pathogens after kidney transplantation. BMC Nephrol 18:164. https://doi.org/10.1186/s12882-017-0580-z CrossRefPubMedPubMedCentral

21.

Parasuraman R, Julian K (2013) Urinary tract infections in solid organ transplantation. Am J Transplant 13 (Suppl 4):327–336. https://doi.org/10.1111/ajt.12124 CrossRefPubMed

22.

Linares L, Cervera C, Cofan F et al (2007) Epidemiology and outcomes of multiple antibiotic-resistant bacterial infection in renal transplantation. Transplant Proc 39:2222–2224. https://doi.org/10.1016/j.transproceed.2007.06.061 CrossRefPubMed

23.

Safdar N, Slattery WR, Knasinski V et al (2005) Predictors and outcomes of candiduria in renal transplant recipients. Clin Infect Dis 40:1413–1421. https://doi.org/10.1086/429620 CrossRefPubMed

24.

Fisher JF, Sobel JD, Kauffman CA, Newman CA (2011) Candida urinary tract infections-treatment. Clin Infect Dis 52 (Suppl 6):S457–S466. https://doi.org/10.1093/cid/cir112 CrossRefPubMed

25.

Chuang P, Parikh CR, Langone A (2005) Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant 19:230–235. https://doi.org/10.1111/j.1399-0012.2005.00327.x CrossRefPubMed

26.

Jung GO, Chun JM, Park JB et al (2008) Clinical significance of posttransplantation vesicoureteral reflux during short-term period after kidney transplantation. Transplant Proc 40:2339–2341. https://doi.org/10.1016/j.transproceed.2008.06.027 CrossRefPubMed

27.

Meier-Kriesche HU, Ojo A, Hanson J et al (2000) Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation 69:885–889CrossRefPubMed

28.

Trouillhet I, Benito N, Cervera C et al (2005) Influence of age in renal transplant infections: cases and controls study. Transplantation 80:989–992CrossRefPubMed

29.

Sqalli TH, Laboudi A, Arrayhani M et al (2008) Urinary tract infections in renal allograft recipients from living related donors. Saudi J Kidney Dis Transplant 19:551–553

30.

Memikoglu KO, Keven K, Sengul S et al (2007) Urinary tract infections following renal transplantation: a single-center experience. Transplant Proc 39:3131–3134. https://doi.org/10.1016/j.transproceed.2007.10.005 CrossRefPubMed

31.

Kamath NS, John GT, Neelakantan N et al (2006) Acute graft pyelonephritis following renal transplantation. Transplant Infect Dis 8:140–147. https://doi.org/10.1111/j.1399-3062.2006.00148.x CrossRef

32.

Tandogdu Z, Cai T, Koves B et al (2016) Urinary tract infections in immunocompromised patients with diabetes, chronic kidney disease, and kidney transplant. Eur Urol Focus 2:394–399. https://doi.org/10.1016/j.euf.2016.08.006 CrossRefPubMed

33.

Papasotiriou M, Savvidaki E, Kalliakmani P et al (2011) Predisposing factors to the development of urinary tract infections in renal transplant recipients and the impact on the long-term graft function. Ren Fail 33:405–410. https://doi.org/10.3109/0886022X.2011.568137 CrossRefPubMed

34.

Wu X, Dong Y, Liu Y et al (2016) The prevalence and predictive factors of urinary tract infection in patients undergoing renal transplantation: a meta-analysis. Am J Infect Control 44:1261–1268. https://doi.org/10.1016/j.ajic.2016.04.222 CrossRefPubMed

35.

Pascual J, Galeano C, Royuela A, Zamora J (2010) A systematic review on steroid withdrawal between 3 and 6 months after kidney transplantation. Transplantation 90:343–349. https://doi.org/10.1097/TP.0b013e3181e58912 CrossRefPubMed

36.

Hanvesakul R, Kubal C, Jham S et al (2008) Increased incidence of infections following the late introduction of mycophenolate mofetil in renal transplant recipients. Nephrol Dial Transplant 23:4049–4053. https://doi.org/10.1093/ndt/gfn387 CrossRefPubMed

37.

Jarzembowski T, Daca A, Witkowski J et al (2013) Changes of PBP5 gene expression in enterococcal isolates from renal transplantation recipients. Biomed Res Int 2013:687156. https://doi.org/10.1155/2013/687156 CrossRefPubMedPubMedCentral

38.

Mulvey MA (2002) Adhesion and entry of uropathogenic Escherichia coli. Cell Microbiol 4:257–271CrossRefPubMed

39.

Anderson GG, Martin SM, Hultgren SJ (2004) Host subversion by formation of intracellular bacterial communities in the urinary tract. Microbes Infect 6:1094–1101. https://doi.org/10.1016/j.micinf.2004.05.023 CrossRefPubMed

40.

Justice SS, Hung C, Theriot JA et al (2004) Differentiation and developmental pathways of uropathogenic Escherichia coli in urinary tract pathogenesis. Proc Natl Acad Sci USA 101:1333–1338. https://doi.org/10.1073/pnas.0308125100 CrossRefPubMed

41.

Wolfe AJ, Toh E, Shibata N et al (2012) Evidence of uncultivated bacteria in the adult female bladder. J Clin Microbiol 50:1376–1383. https://doi.org/10.1128/JCM.05852-11 CrossRefPubMedPubMedCentral

42.

Ragnarsdóttir B, Lutay N, Grönberg-Hernandez J et al (2011) Genetics of innate immunity and UTI susceptibility. Nat Rev Urol 8:449CrossRefPubMed

43.

Lundstedt A-C, McCarthy S, Gustafsson MCU et al (2007) A genetic basis of susceptibility to acute pyelonephritis. PLoS One 2:e825. https://doi.org/10.1371/journal.pone.0000825 CrossRefPubMedPubMedCentral

44.

Lyerova L, Lacha J, Skibova J et al (2001) Urinary tract infection in patients with urological complications after renal transplantation with respect to long-term function and allograft survival. Ann Transplant 6:19–20PubMed

45.

Trzeciak S, Sharer R, Piper D et al (2004) Infections and severe sepsis in solid-organ transplant patients admitted from a university-based ED. Am J Emerg Med 22:530–533CrossRefPubMed

46.

Rao KV, Andersen RC (1988) Long-term results and complications in renal transplant recipients. Observations in the second decade. Transplantation 45:45–52CrossRefPubMed

47.

Schmaldienst S, Dittrich E, Horl WH (2002) Urinary tract infections after renal transplantation. Curr Opin Urol 12:125–130CrossRefPubMed

48.

Dupont PJ, Psimenou E, Lord R et al (2007) Late recurrent urinary tract infections may produce renal allograft scarring even in the absence of symptoms or vesicoureteric reflux. Transplantation 84:351–355. https://doi.org/10.1097/01.tp.0000275377.09660.fa CrossRefPubMed

49.

Tawab KA, Gheith O, Al Otaibi T et al (2017) Recurrent urinary tract infection among renal transplant recipients: risk factors and long-term outcome. Exp Clin Transplant 15:157–163. https://doi.org/10.6002/ect.2016.0069 CrossRefPubMed

50.

Pesce F, Martino M, Fiorentino M et al (2019) Recurrent urinary tract infections in kidney transplant recipients during the first-year influence long-term graft function: a single-center retrospective cohort study. J Nephrol. https://doi.org/10.1007/s40620-019-00591-5 CrossRefPubMed

51.

Mitra S, Alangaden GJ (2011) Recurrent urinary tract infections in kidney transplant recipients. Curr Infect Dis Rep 13:579–587. https://doi.org/10.1007/s11908-011-0210-z CrossRefPubMed

52.

El Amari EB, Hadaya K, Buhler L et al (2011) Outcome of treated and untreated asymptomatic bacteriuria in renal transplant recipients. Nephrol Dial Transplant 26:4109–4114. https://doi.org/10.1093/ndt/gfr198 CrossRefPubMed

53.

Green H, Rahamimov R, Gafter U et al (2011) Antibiotic prophylaxis for urinary tract infections in renal transplant recipients: a systematic review and meta-analysis. Transplant Infect Dis 13:441–447. https://doi.org/10.1111/j.1399-3062.2011.00644.x CrossRef

54.

(2009) KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 9 Suppl 3:S1–S155. https://doi.org/10.1111/j.1600-6143.2009.02834.x

55.

Horwedel TA, Bowman LJ, Saab G, Brennan DC (2014) Benefits of sulfamethoxazole-trimethoprim prophylaxis on rates of sepsis after kidney transplant. Transplant Infect Dis 16:261–269. https://doi.org/10.1111/tid.12196 CrossRef

56.

Ziakas PD, Pliakos EE, Zervou FN et al (2014) MRSA and VRE colonization in solid organ transplantation: a meta-analysis of published studies. Am J Transplant 14:1887–1894. https://doi.org/10.1111/ajt.12784 CrossRefPubMed

57.

Garzoni C, Vergidis P (2013) Methicillin-resistant, vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus infections in solid organ transplantation. Am J Transplant 13:50–58. https://doi.org/10.1111/ajt.12098 CrossRefPubMed

58.

Kullar R, Davis SL, Levine DP et al (2011) High-dose daptomycin for treatment of complicated gram-positive infections: a large, multicenter, retrospective study. Pharmacother J Hum Pharmacol Drug Ther 31:527–536. https://doi.org/10.1592/phco.31.6.527 CrossRef

59.

Russell DL, Flood A, Zaroda TE et al (2008) Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant 8:1737–1743. https://doi.org/10.1111/j.1600-6143.2008.02304.x CrossRefPubMed

60.

Patel R, Gallagher JC (2015) Vancomycin-resistant enterococcal bacteremia pharmacotherapy. Ann Pharmacother 49:69–85. https://doi.org/10.1177/1060028014556879 CrossRefPubMed

61.

Chuang Y-C, Wang J-T, Lin H-Y, Chang S-C (2014) Daptomycin versus linezolid for treatment of vancomycin-resistant enterococcal bacteremia: systematic review and meta-analysis. BMC Infect Dis 14:687. https://doi.org/10.1186/s12879-014-0687-9 CrossRefPubMedPubMedCentral

62.

Yuan X, Liu T, Wu D, Wan Q (2018) Epidemiology, susceptibility, and risk factors for acquisition of MDR/XDR Gram-negative bacteria among kidney transplant recipients with urinary tract infections. Infect Drug Resist 11:707–715. https://doi.org/10.2147/IDR.S163979 CrossRefPubMedPubMedCentral

63.

Cervera C, van Delden C, Gavaldà J et al (2014) Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect 20:49–73. https://doi.org/10.1111/1469-0691.12687 CrossRefPubMed

64.

Sousa D, Castelo-Corral L, Gutierrez-Urbon J-M et al (2013) Impact of ertapenem use on Pseudomonas aeruginosa and Acinetobacter baumannii imipenem susceptibility rates: collateral damage or positive effect on hospital ecology? J Antimicrob Chemother 68:1917–1925. https://doi.org/10.1093/jac/dkt091 CrossRefPubMed

65.

Rivers E, Nguyen B, Havstad S et al (2001) Early goal-directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377. https://doi.org/10.1056/NEJMoa010307 CrossRefPubMed

66.

Livigni S, Bertolini G, Rossi C et al (2014) Efficacy of coupled plasma filtration adsorption (CPFA) in patients with septic shock: a multicenter randomised controlled clinical trial. BMJ Open 4:e003536. https://doi.org/10.1136/bmjopen-2013-003536 CrossRefPubMedPubMedCentral

67.

Whiteside SA, Razvi H, Dave S et al (2015) The microbiome of the urinary tract—a role beyond infection. Nat Rev Urol 12:81–90. https://doi.org/10.1038/nrurol.2014.361 CrossRefPubMed

68.

Pearce MM, Hilt EE, Rosenfeld AB et al (2014) The female urinary microbiome: a comparison of women with and without urgency urinary incontinence. MBio 5:e01283–e01214. https://doi.org/10.1128/mBio.01283-14 CrossRefPubMedPubMedCentral

69.

Siddiqui H, Lagesen K, Nederbragt AJ et al (2012) Alterations of microbiota in urine from women with interstitial cystitis. BMC Microbiol 12:205. https://doi.org/10.1186/1471-2180-12-205 CrossRefPubMedPubMedCentral

70.

Fouts DE, Pieper R, Szpakowski S et al (2012) Integrated next-generation sequencing of 16S rDNA and metaproteomics differentiate the healthy urine microbiome from asymptomatic bacteriuria in neuropathic bladder associated with spinal cord injury. J Transl Med 10:174. https://doi.org/10.1186/1479-5876-10-174 CrossRefPubMedPubMedCentral

71.

Yatsunenko T, Rey FE, Manary MJ et al (2012) Human gut microbiome viewed across age and geography. Nature 486:222–227. https://doi.org/10.1038/nature11053 CrossRefPubMedPubMedCentral

72.

Hummelen R, Macklaim JM, Bisanz JE et al (2011) Vaginal microbiome and epithelial gene array in post-menopausal women with moderate to severe dryness. PLoS One 6:e26602. https://doi.org/10.1371/journal.pone.0026602 CrossRefPubMedPubMedCentral

73.

Gupta K, Hillier SL, Hooton TM et al (2000) Effects of contraceptive method on the vaginal microbial flora: a prospective evaluation. J Infect Dis 181:595–601. https://doi.org/10.1086/315267 CrossRefPubMed

74.

Habash MB, Van der Mei HC, Busscher HJ, Reid G (1999) The effect of water, ascorbic acid, and cranberry derived supplementation on human urine and uropathogen adhesion to silicone rubber. Can J Microbiol 45:691–694CrossRefPubMed

75.

Swann JR, Tuohy KM, Lindfors P et al (2011) Variation in antibiotic-induced microbial recolonization impacts on the host metabolic phenotypes of rats. J Proteome Res 10:3590–3603. https://doi.org/10.1021/pr200243t CrossRefPubMed

76.

Barclay J, Veeratterapillay R, Harding C (2017) Non-antibiotic options for recurrent urinary tract infections in women. BMJ 359:j5193. https://doi.org/10.1136/bmj.j5193 CrossRefPubMed

77.

O’Kane DB, Dave SK, Gore N et al (2016) Urinary alkalisation for symptomatic uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 4:CD010745. https://doi.org/10.1002/14651858.CD010745.pub2 CrossRefPubMed

78.

Schwenger EM, Tejani AM, Loewen PS (2015) Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD008772.pub2 CrossRefPubMed

79.

Perrotta C, Aznar M, Mejia R et al (2008) Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005131.pub2 CrossRefPubMed

80.

Jepson RG, Craig JC (2007) A systematic review of the evidence for cranberries and blueberries in UTI prevention. Mol Nutr Food Res 51:738–745. https://doi.org/10.1002/mnfr.200600275 CrossRefPubMed

81.

Jepson RG, Williams G, Craig JC (2012) Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 10:CD001321. https://doi.org/10.1002/14651858.CD001321.pub5 CrossRefPubMed

82.

Kranjcec B, Papes D, Altarac S (2014) d-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol 32:79–84. https://doi.org/10.1007/s00345-013-1091-6 CrossRefPubMed

83.

Ferry SA, Holm SE, Stenlund H et al (2004) The natural course of uncomplicated lower urinary tract infection in women illustrated by a randomized placebo controlled study. Scand J Infect Dis 36:296–301CrossRefPubMed

Title: Updates on urinary tract infections in kidney transplantation
Authors: Marco Fiorentino
Francesco Pesce
Antonio Schena
Simona Simone
Giuseppe Castellano
Loreto Gesualdo
Publication date: 01-10-2019
Publisher: Springer International Publishing
Keywords: Kidney Transplantation
Pyelonephritis
Antibiotic
Kidney Transplantation
Kidney Transplantation
Respiratory Microbiota
Urinary Tract Infection
Kidney Transplantation
Kidney Transplantation
Pyelonephritis
Kidney Transplantation
Urosepticemia
Published in: Journal of Nephrology / Issue 5/2019
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI: https://doi.org/10.1007/s40620-019-00585-3

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2019

The relationship between the concentration of plasma homocysteine and chronic kidney disease: a cross sectional study of a large cohort

Correction to: Role of anemia and proteinuria in the development of subsequent renal function deterioration in a general population with preserved glomerular filtration rate: a community-based cohort study

Lipopolysaccharide in systemic circulation induces activation of inflammatory response and oxidative stress in cardiorenal syndrome type 1

Interferon-free regimens improve kidney function in patients with chronic hepatitis C infection

Homocysteine and chronic kidney disease: an ongoing narrative

When kidneys and lungs suffer together

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials