Methods: A single center retrospective cohort study of renal transplant recipients at a tertiary care, academic medical center from May 1, 2010 to January 31, 2015. Data on epidemiology, comorbidities, donor cultures, number of UTIs, days of foley catheter use, and antibiotic therapy were obtained from the electronic medical record and transplant patient database. Inclusion criteria: >18 years old post kidney transplant during the study period. Exclusion criteria: rUTI prior to transplant or anatomical abnormality of native kidney(s). Definitions: Early post-transplant (EPT): <28 days after transplant. Positive culture: growth of >10^5 cfu/ml. UTI-(fever, dysuria, +/- allograft or suprapubic pain) + positive culture. EAB-asymptomatic bacteriuria in the EPT period. rUTI: ≥ 3 UTIs in 1 year or 2 UTIs in 6 consecutive months within the year post-transplant. UTI episodes were considered separate if occurred >3 weeks after completion of prior antibiotics. Data was analyzed by Fischer's exact test and Chi-square test.
Results: 369 patients were included; 40.4% had EAB and 6% had a UTI in the EPT (eUTI). rUTI occurred in 5.7% of patients (n=21). In the rUTI group, 8 (38.1%) had EAB, 8 (38.1%) had eUTI, and 5 (23.8%) had neither (p=0.067). rUTI developed in 5.3% (8/149) of the EAB group versus 36.4% (8/22) of the eUTI group (p<0.005). No other variables were associated with rUTI. Total UTI episodes was greater with eUTI than EAB (mean 2.09 vs. 0.28, 95% CI 2.2-1.4, p<0.005).
Conclusion: Only eUTI increased the risk for rUTI. Although screening for bacteriuria is a common practice post-transplant, our data indicates that aggressive symptom screening would better predict likelihood of rUTI and in turn graft dysfunction. Future studies should address the potential benefit of prolonged prophylactic trimethoprim/sufamethoxazole in preventing rUTI.
M. Bandres, None