Skip to main content

Advertisement

Log in

Recurrent Urinary Tract Infections in Kidney Transplant Recipients

  • Urinary Tract Infections (Jack D. Sobel, Section Editor)
  • Published:
Current Infectious Disease Reports Aims and scope Submit manuscript

Abstract

Urinary tract infections (UTIs) are the most common infectious complication after kidney transplantation (KT). Recurrent UTIs after KT can contribute to increased morbidity and may also be associated with graft loss and mortality. Though several risk factors like female gender, diabetes mellitus, presence of ureteric stents, native kidney disease with urological malformations and re-transplantation have been associated with recurrent UTIs after KT, vesicoureteric reflux appears to be a unique risk factor in this patient population. The emergence of drug-resistant pathogens as causative agents for post-transplant recurrent UTIs poses a significant therapeutic challenge. The use of pathogen-specific antibiotic therapy guided by culture and sensitivity data is warranted. The optimal duration of antimicrobial therapy for recurrent UTIs in renal transplant recipients remains uncertain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 2009 OPTN/SRTR annual report. Available at http://www.ustransplant.org/annual_reports/current/default.htm. Accessed March 15, 2011

  2. Alangaden GJ, Thyagarajan R, Gruber SA, et al. Infectious complications after kidney transplantation: current epidemiology and associated risk factors. Clin Transplant. 2006;20:401–9. doi:10.1111/j.1399-0012.2006.00519.x.

    Article  PubMed  Google Scholar 

  3. Alangaden G. Urinary tract infections in renal transplant recipients. Curr Infect Dis Rep. 2007;9:475–9.

    Article  PubMed  Google Scholar 

  4. Veroux M, Giuffrida G, Corona D, et al. Infective complications in renal allograft recipients: epidemiology and outcome. Transplant Proc. 2008;40:1873–6. doi:10.1016/j.transproceed.2008.05.065.

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  6. Abbott KC, Oliver 3rd JD, Hypolite I, et al. Hospitalizations for bacterial septicemia after renal transplantation in the united states. Am J Nephrol. 2001;21:120–7.

    Article  PubMed  CAS  Google Scholar 

  7. Abbott KC, Swanson SJ, Richter ER, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis. 2004;44:353–62.

    Article  PubMed  Google Scholar 

  8. Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant. 2005;19:230–5. doi:10.1111/j.1399-0012.2005.00327.x.

    Article  PubMed  Google Scholar 

  9. • Song JC, Hwang HS, Yoon HE, et al. Endoscopic subureteral polydimethylsiloxane injection and prevention of recurrent acute graft pyelonephritis. Nephron Clin Pract. 2010;117:c385–c9. doi:10.1159/000321526. A recent study evaluating the effect of subureteral polydimethylsiloxane (PDS) Injection for the correction of VUR and recurrence of AGPN in KT recipients.

    Article  PubMed  Google Scholar 

  10. • Dupont PJ, Psimenou E, Lord R, et al. Late recurrent urinary tract infections may produce renal allograft scarring even in the absence of symptoms or vesicoureteric reflux. Transplantation. 2007;84:351–5. doi:10.1097/01.tp.0000275377.09660.fa. A retrospective study of late-onset recurrent UTIs that identified renal scarring in patients with late recurrent UTIs, though this was not associated with graft loss.

    Article  PubMed  Google Scholar 

  11. Raygada RL, Doshi M, Gruber SA, et al. Symptomatic urinary tract infections in renal transplant recipients: 6 year experience at a single transplant center. Presented at the 48th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; Washington, DC, October 25–28, 2008

  12. Albert X, Huertas I, Pereiro II, et al. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev. 2004;(3):CD001209. doi:10.1002/14651858.CD001209.pub2

  13. • Kamath NS, John GT, Neelakantan N, et al. Acute graft pyelonephritis following renal transplantation. Transpl Infect Dis. 2006;8(3):140–7. doi:10.1111/j.1399-3062.2006.00148.x. A retrospective study of 1022 KT recipients over a 10 year period. Authors observed that placement of ureteric stent, CMV disease and native kidney disease with urological malformations were associated with recurrent AGPN episodes.

    Article  PubMed  CAS  Google Scholar 

  14. Giral M, Pascuariello G, Karam G, et al. Acute graft pyelonephritis and long-term kidney allograft outcome. Kidney Int. 2002;61:1880–6. doi:10.1046/j.1523-1755.2002.00323.x.

    Article  PubMed  Google Scholar 

  15. Memikoglu KO, Keven K, Sengul S, et al. Urinary tract infections following renal transplantation: a single-center experience. Transplant Proc. 2007;39:3131–4. doi:10.1016/j.transproceed.2007.10.005.

    Article  PubMed  CAS  Google Scholar 

  16. Goya N, Tanabe K, Iguchi Y, et al. Prevalence of urinary tract infection during outpatient follow-up after renal transplantation. Infection. 1997;25:101–5.

    Article  PubMed  CAS  Google Scholar 

  17. Valera B, Gentil MA, Cabello V, et al. Epidemiology of urinary infections in renal transplant recipients. Transplant Proc. 2006;38:2414–5. doi:10.1016/j.transproceed.2006.08.018.

    Article  PubMed  CAS  Google Scholar 

  18. Chan PC, Cheng IK, Wong KK, et al. Urinary tract infections in post-renal transplant patients. Int Urol Nephrol. 1990;22(4):389–96.

    Article  PubMed  CAS  Google Scholar 

  19. Schmaldienst S, Dittrich E, Horl WH. Urinary tract infections after renal transplantation. Curr Opin Urol. 2002;12:125–30.

    Article  PubMed  Google Scholar 

  20. Senger SS, Arslan H, Azap OK, et al. Urinary tract infections in renal transplant recipients. Transplant Proc. 2007;39:1016–7. doi:10.1016/j.transproceed.2007.02.060.

    Article  PubMed  CAS  Google Scholar 

  21. Sobel JD, Kaye D. Urinary tract infections. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and practice of infectious diseases. Philadelphia: Churchill Livingstone Elsevier; 2010. p. 957–85.

    Google Scholar 

  22. Buckley O, Geoghegan T, O'Brien J, Torreggiani WC. Vesicoureteric reflux in the adult. Br J Radiol. 2007;80(954):392–400. doi:10.1259/bjr/60682848.

    Article  PubMed  CAS  Google Scholar 

  23. Wilson CH, Bhatti AA, Rix DA, Manas DM. Routine intraoperative ureteric stenting for kidney transplant recipients. Cochrane Database Syst Rev. 2005;(4):CD004925. doi:10.1002/14651858.CD004925.pub2

  24. Pinheiro HS, Mituiassu AM, Carminatti M, et al. Urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in kidney transplant patients. Transplant Proc. 2010;42:486–7. doi:10.1016/j.transproceed.2010.02.002.

    Article  PubMed  CAS  Google Scholar 

  25. Maillard O, Corvec S, Dantal J, et al. Emergence of high ampicillin-resistant enterococcus faecium isolates in a kidney transplant ward: role of antibiotic pressure and cross transmission. Microb Drug Resist. 2010;16(2):123–8. doi:10.1089/mdr.2009.0095.

    Article  PubMed  CAS  Google Scholar 

  26. Rivera-Sanchez R, Delgado-Ochoa D, Flores-Paz RR, et al. Prospective study of urinary tract infection surveillance after kidney transplantation. BMC Infect Dis. 2010;10:245. doi:10.1186/1471-2334-10-245.

    Article  PubMed  Google Scholar 

  27. Nankivell BJ, Cohn DA, Spicer ST, et al. Diagnosis of kidney transplant obstruction using Mag3 diuretic renography. Clin Transplant. 2001;15(1):11–8.

    Article  PubMed  CAS  Google Scholar 

  28. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103–20. doi:10.1093/cid/ciq257.

    Article  PubMed  Google Scholar 

  29. Saemann M, Horl WH. Urinary tract infection in renal transplant recipients. Eur J Clin Invest. 2008;38 Suppl 2:58–65. doi:10.1111/j.1365-2362.2008.02014.x.

    Article  PubMed  CAS  Google Scholar 

  30. Maraha B, Bonten H, van Hooff H, et al. Infectious complications and antibiotic use in renal transplant recipients during a 1-year follow-up. Clin Microbiol Infect. 2001;7(11):619–25.

    Article  PubMed  CAS  Google Scholar 

  31. Rabkin DG, Stifelman MD, Birkhoff J, et al. Early catheter removal decreases incidence of urinary tract infections in renal transplant recipients. Transplant Proc. 1998;30(8):4314–6.

    Article  PubMed  CAS  Google Scholar 

  32. Renoult E, Aouragh F, Mayeux D, et al. Factors influencing early urinary tract infections in kidney transplant recipients. Transplant Proc. 1994;26(4):2056–8.

    PubMed  CAS  Google Scholar 

  33. Munoz P. Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis. 2001;33 Suppl 1:S53–7. doi:10.1086/320905.

    Article  PubMed  CAS  Google Scholar 

  34. Fox BC, Sollinger HW, Belzer FO, Maki DG. A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora, and the cost-benefit of prophylaxis. Am J Med. 1990;89(3):255–74.

    Article  PubMed  CAS  Google Scholar 

  35. Maki DG, Fox BC, Kuntz J, et al. A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation. Side effects of trimethoprim-sulfamethoxazole, interaction with cyclosporine. J Lab Clin Med. 1992;119(1):11–24.

    PubMed  CAS  Google Scholar 

  36. Khosroshahi HT, Mogaddam AN, Shoja MM. Efficacy of high-dose trimethoprim-sulfamethoxazol prophylaxis on early urinary tract infection after renal transplantation. Transplant Proc. 2006;38(7):2062–4. doi:10.1016/j.transproceed.2006.06.111.

    Article  PubMed  CAS  Google Scholar 

  37. Reek C, Noster M, Burmeister D, et al. Urological complications of renal transplantation: a series of 900 cases. Transplant Proc. 2003;35(6):2106–7.

    Article  PubMed  CAS  Google Scholar 

  38. Hibberd PL, Tolkoff-Rubin NE, Doran M, et al. Trimethoprim-sulfamethoxazole compared with ciprofloxacin for the prevention of urinary tract infection in renal transplant recipients. A double-blind, randomized controlled trial. Online J Curr Clin Trials. 1992;Doc No 15:[4083 words; 46 paragraphs]

  39. Bottiger Y, Brattstrom C, Backman L, et al. Trimethoprim-sulphamethoxazole does not affect the pharmacokinetics of sirolimus in renal transplant recipients. Br J Clin Pharmacol. 2005;60(5):566–9. doi:10.1111/j.1365-2125.2005.02475.x.

    Article  PubMed  Google Scholar 

  40. Moyses Neto M, Costa RS, Reis MA, et al. Use of ciprofloxacin as a prophylactic agent in urinary tract infections in renal transplant recipients. Clin Transplant. 1997;11(5 Pt 1):446–52.

    PubMed  CAS  Google Scholar 

  41. Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008;(1):CD001321. doi:10.1002/14651858.CD001321.pub4

  42. Perrotta C, Aznar M, Mejia R, et al. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008;(2):CD005131. doi:10.1002/14651858.CD005131.pub2

  43. Damiano R, Quarto G, Bava I, et al. Prevention of recurrent urinary tract infections by intravesical administration of hyaluronic acid and chondroitin sulphate: a placebo-controlled randomised trial. Eur Urol. 2011;59(4):645–51. doi:10.1016/j.eururo.2010.12.039.

    Article  PubMed  CAS  Google Scholar 

  44. Reid G, Bruce AW. Low vaginal pH and urinary-tract infection. Lancet. 1995;346(8991–8992):1704.

    Article  PubMed  CAS  Google Scholar 

  45. Rayes N, Seehofer D, Theruvath T, et al. Supply of pre- and probiotics reduces bacterial infection rates after liver transplantation—a randomized, double-blind trial. Am J Transplant. 2005;5(1):125–30. doi:10.1111/j.1600-6143.2004.00649.x.

    Article  PubMed  Google Scholar 

  46. Antonopoulos IM, Piovesan AC, Falci Jr R, et al. Transurethral injection therapy with carbon-coated beads (durasphere) for treatment of recurrent pyelonephritis in kidney transplant patients with vesico-ureteral reflux to the allograft. Clin Transplant. 2010. doi:10.1111/j.1399-0012.2010.01242.x.

  47. Puri P, Ninan GK, Surana R. Subureteric Teflon Injection (STING). Results of a European survey. Eur Urol. 1995;27:71–5.

    PubMed  CAS  Google Scholar 

  48. Aaronson IA, Rames RA, Greene WB, et al. Endoscopic treatment of reflux: migration of teflon to the lungs and brain. Eur Urol. 1993;23:394–9.

    PubMed  CAS  Google Scholar 

  49. Ozok U, Eroglu M, Imamoglu A, et al. Subureteral dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux in transplant candidates. J Endourol. 2005;19:1185–7. doi:10.1089/end.2005.19.1185.

    Article  PubMed  Google Scholar 

  50. Hurst FP, Neff RT, Falta EM, et al. Incidence, predictors, and associated outcomes of prostatism after kidney transplantation. Clin J Am Soc Nephrol. 2009;4:329–36. doi:10.2215/CJN.04370808.

    Article  PubMed  Google Scholar 

  51. Sulikowski T, Tejchman K, Zietek Z, et al. Experience with autosomal dominant polycystic kidney disease in patients before and after renal transplantation: a 7-year observation. Transplant Proc. 2009;41:177–80. doi:10.1016/j.transproceed.2008.10.034.

    Article  PubMed  CAS  Google Scholar 

  52. Knispel HH, Klan R, Offermann G, Miller K. Transplantation in autosomal dominant polycystic kidney disease without nephrectomy. Urol Int. 1996;56:75–8.

    Article  PubMed  CAS  Google Scholar 

  53. Rozanski J, Kozlowska I, Myslak M, et al. Pretransplant nephrectomy in patients with autosomal dominant polycystic kidney disease. Transplant Proc. 2005;37:666–8. doi:10.1016/j.transproceed.2004.12.115.

    Article  PubMed  CAS  Google Scholar 

  54. Power RE, Hickey DP, Little DM. Urological evaluation prior to renal transplantation. Transplant Proc. 2004;36:2962–7. doi:10.1016/j.transproceed.2004.11.006.

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George John Alangaden.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mitra, S., Alangaden, G.J. Recurrent Urinary Tract Infections in Kidney Transplant Recipients. Curr Infect Dis Rep 13, 579–587 (2011). https://doi.org/10.1007/s11908-011-0210-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11908-011-0210-z

Keywords

Navigation