Urinary Tract Infections after Kidney Transplantation in Fourteen Medical Centers in Turkey

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Abstract

Introduction

Urinary tract infection (UTI) is the most common complication after kidney transplantation. It may cause prolonged hospitalization, severe sepsis and graft loss. The aim of this study was to evaluate the number of UTIs that occur after kidney transplantation (KT) and to identify the antimicrobial resistant causative agents.

Materials and Methods

We retrospectively analyzed all the KTs performed between the dates 1st June 2016 and 30th May 2017 and the positive urine cultures of these patients in fourteen different medical centers in seven cities of Turkey.

Results

A total of 488 adult patients underwent transplantation during twelve months period, male gender was predominant with the ratio of 62%. UTI developed in 152 patients (31%), most of the UTIs (40%) were in the period between the second week and the first month after transplantation. In this study 153 UTI attacks were symptomatic and most of patients (%70) had upper urinary tract symptoms. The most common causative agent was Escherichia coli (86) followed by Klebsiella spp. (61). Ratios of extended spectrum beta-lactamase (ESBL) producing Klebsiella spp. and E.coli were respectively 65% and 64%. The ratio of carbapenem resistant Klebsiella spp. strains was 21%, vancomycin resistant enterococcus 3%. Trimethoprim- sulfamethoxazole resistance of all gram negative agents was 60%. We determined nineteen patients with candiduria in this period.

Conclusion

Increasing antibacterial resistance is a major concern for the management of urinary tract infections after kidney transplantation in our country. Accordingly, in this study the high ratios of ESBL producing E.coli and Klebsiella spp. strains and also carbapenem resistance of Klebsiella spp. strains cause difficulties in the empirical treatment in Turkey.

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