1087. Recurrent Urinary Tract Infections after Renal Transplantation
Session: Poster Abstract Session: Infections After Solid Organ Transplants
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Urinary tract infections (UTIs) are the commonest infectious complication after renal transplantation (RT). The epidemiology and risk factors for symptomatic recurrent UTIs in this patient (pt) population has not been well studied.

Methods: 

Medical records of patients who underwent RT and subsequently developed recurrent UTIs from January 2003 to February 2011 were reviewed. UTI was defined as:  a) presence of ≥1 of the following: fever, urgency, frequency, dysuria, suprapubic or renal angle tenderness and  positive urine culture with ≥105 CFU/ml or (b) ≥2 of the above signs/symptoms and one of the following: positive leukocyte esterase and/or nitrate, pyuria (≥10 WBC/hpf), or urine culture with ≤105 CFU/ml if on antibiotics. Recurrent UTI was defined as ≥ 3 episodes in 1 year or ≥2 episodes within 6months (mo).

Results: 

A total of 498 UTIs were recorded in 190 pts during the study period. Recurrent UTIs occurred in 70(36.8%) pts. 64% pts in the recurrent UTI group were female compared to 38% among pts with single UTI post-RT ( p<0.05). Recurrent UTI was more likely in pts with urological problems (20% vs 6%; p<0.05) and if the donor sex was female (47% vs 31%; p<0.05) compared with pts with single UTI. Diabetes mellitus, re-transplants, CMV status and ureteral stents were not associated with increased risk of recurrent UTIs. E. coli, Klebsiella sp. and Enterococcus sp. were the commonest uropathogens isolated from 60%, 40% and 40% of pts with recurrent UTI respectively. Graft loss was observed in 30% patients with recurrent UTI vs 26% with single UTI. 

Conclusion:

More than a third of pts developed recurrent UTIs after RT. Female gender and urological problems are significant risk factors for recurrent UTIs in this population. E.coli remains the most common organism isolated, though Enterococcus sp. has emerged as a major uropathogen in RT recipients with recurrent UTI. Investigations to identify correctable urological abnormalities are warranted in RT pts with recurrent UTI.


Subject Category: O. Transplant infectious diseases

Subhashis Mitra, MD1, Shyam Shah, MD2, Mona Doshi, MD3, Atul Singh, MD4, Salman Khan, MD4, Diane Sternbauer, RN5, Kathy Morawaski, RN5, Sanjay Revankar, MD6, Pranatharthi Chandrasekar, MD7 and George Alangaden, MD8, (1)Infectious Diseases, Detroit Medical Center/ Wayne State University, Detroit, MI, (2)Infectious Diseases, Detroit Medical Center, Detroit, MI, (3)Wayne State Univ. Sch. of Med., Detroit, MI, (4)Nephrology, Detroit Medical Center/ Wayne State University, Detroit, MI, (5)Transplant Surgery, Detroit Medical Center, Detroit, MI, (6)Infectious diseases, Wayne State University, Detroit, MI, (7)Infectious diseases, Wayne State Univiversity, Detroit, MI, (8)Detroit Medical Center/Wayne State University, Detroit, MI

Disclosures:

S. Mitra, None

S. Shah, None

M. Doshi, None

A. Singh, None

S. Khan, None

D. Sternbauer, None

K. Morawaski, None

S. Revankar, None

P. Chandrasekar, None

G. Alangaden, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.