Urinary Tract Infection by Multiresistant Enterobacteriaceae in a Renal Transplant Center

Abstract

Urinary tract infections (UTI) are the most frequent complication in renal transplant patients. Our aims were to determine the most common pathogens, the association of different enterobacterias with the time of the onset of the infection, the impact of several risk factors and antibiotic susceptibility.
Materials and Methods: The patients were monitored for a year after the renal transplant from November 2006 to February 2012. A retrospective analysis was done and the first positive urine culture with gram negative bacilli was included.
Results: From a total of 156 patients analyzed, 63 (40%) had at least one experience of UTI in which the responsible microorganisms were characterized. The most common pathogen was Klebsiella pneumoniae (25/63 episodes, 39 %), followed by Escherichia coli (23/63, 37 %). Almost half of the cases (31/63, 49%) occurred within 30 days (58% for K. pneumoniae), one third of them (18/63, 29%) between 31 and 180 days (39% for E. coli) and the remainings (14/ 63, 22%) in the next half year (64% of them caused by E. coli). Most of the K. pneumoniae, (22/25, 88%) were extended spectrum ß lactamases producers. We can mention as predisposing risk factors: female gender, lithiasis and urinary stent presence.
Conclusion: This study confirms that UTIs are a frequent complication in renal transplantation. The association of multiresistant K. pneumoniae infections with immediate UTI can be considered as a marker of nosocomial infection, and points out intervention as a possibility to modify this impact.