Female gender, ureteral catheterization, and comorbidities are among the risk factors for urinarytract infection (UTI) among renal transplant recipients, new study findingssuggest.
The observational, cross-sectionalstudy, by Alparslan Ersoy, MD, ofUludag University Medical Schoolin Bursa, Turkey, and colleagues,included 213 patients who underwentrenal transplantation. Of these, 106were diagnosed with 171 episodes ofUTI, with recurrent UTI in 39 cases(36.8%). First UTIs occurred at amean of 13.7 months after transplantation.The UTI group had a significantlygreater proportion of femalerecipients than the non-UTI group(60.4% vs. 21.5%).
The rate and duration of ureteralcatheterization were significantlygreater in the UTI than non-UTIgroup (48.1% vs. 28% and 66.1 vs.55.9 days, respectively), as was the proportionof patients with comorbidities(43.4% vs. 27.1%).
In regression analysis, female gender,ureteral catheterization, and co-morbiddiseases were independently associatedwith a significant 6.8, 2.8, and 2.3 timesincreased risk of UTI, respectively. Therisk of recurrent UTIs was 4.2 timeshigher among diabetic than non-diabeticrecipients. Among patients withrecurrent UTI, 1 had 5 episodes, 4 had4 episodes, 15 had 3 episodes, and 19had 2 episodes.
The UTI and non-UTI groups weresimilar with respect to donor type, primarydisease, diabetes mellitus, acuterejection, and surgical complications,according to the investigators.
In a separate study of 1,019 transplantrecipients presented at the meeting,researchers in Kuwait identified age,female gender, thymoglobulin induction,pretransplant urologic problems,and hepatitis C as risk factors for recurrentUTI in renal transplant recipients.The investigators divided patients into2 groups: patients who had recurrentUTI (group 1) and those who had no ornon-recurrent UTI) (group 2). Group1 was significantly younger than group2 (34.9 vs. 42.8 years); they also hada significantly higher proportion offemale patients. Recurrent UTI didnot adversely impact graft or patientsurvival.
These new studies add to a growingbody of literature on UTI riskfactors after kidney transplantation.In a recently published study inMedicine (2015;94:e594), researchersdemonstrated that vitamin Ddeficiency is an independent riskfactor for post-transplant UTI. Astudy published in TransplantationProceedings (2014;46:3455-3458)found that the only risk factor forUTI after renal transplantation wasgender, with female recipients athigher risk than male recipients.
Also in Transplantation Proceedings(2014;46:1757-1759), investigatorsreported on a study that identifiedolder age (independent of gender),biopsy-proven acute rejection episodes,and receipt of kidneys from deceaseddonors as UTI risk factors. For femalerecipients, an additional risk factorwas the number of pretransplantpregnancies. Researchers reported inTransplantation (2013;96:732-738) thattheir study of 1,166 kidney transplantrecipients showed that post-transplantUTI risk factors included female gender,prolonged use of Foley catheters,ureteral stents, age, and delayed graftfunction.