Background Urinary tract infection (UTI) is a well-recognized early complication in renal transplant recipients (RTR) and can have significant bearing on their outcome. The recent rise in incidence of extended spectrum beta lactamase (ESBL) producing bacteria causing UTI among RTR poses new and significant challenges in terms of management and outcome. Our aim is to analyze the effect of ESBL producing bacteria causing UTI in these patients and its impact on allograft function. Methods We reviewed the medical records of 147 RTR who were followed at a tertiary care hospital affiliated transplant center between January 2007 and May 2013 and noted five RTR who developed episodes of ESBL producing bacteria related UTI during follow up. Multiple patient characteristics including demographics, immunosuppression, recurrences, allograft function and outcome were analyzed. Results Five patients (3.4%) out of 147 had ESBL producing bacteria related UTI. We found all patients to be above 60 years of age, with three out of five being females, and all five patients had diabetes mellitus. We identified a total of 37 episodes of UTI among these five patients during this period. Two of these patients had elevated creatinine values during the episodes of UTI and three of them developed bacteremia. Of the five patients, four of them had a favorable outcome except for one patient who developed persistent allograft dysfunction. Conclusion RTR are at a higher risk for developing ESBL producing bacteria associated UTI. Early diagnosis along with appropriate and judicious use of antibiotics will ensure long term success in allograft and patient outcome.
References
[1]
Kee T, Lu YM, Vathsala A (2004) Spectrum of severe infections in an Asian renal transplant population. Transplant Proc. 36(7): 2001–3. doi: 10.1016/j.transproceed.2004.08.121
[2]
Abbott KC, Oliver JD 3rd, Hypolite I, Lepler LL, Kirk AD, et al. (2001) Hospitalizations for bacterial septicemia after renal transplantation in the united states. Am J Nephrol. 21(2): 120–7. doi: 10.1159/000046234
[3]
Müller V, Becker G, Delfs M, Albrecht KH, Philipp T, et al. (1998) Do urinary tract infections trigger chronic kidney transplant rejection in man? J Urol. 159(6): 1826–9. doi: 10.1016/s0022-5347(01)63165-3
[4]
Dantas SR, Kuboyama RH, Mazzali M, Moretti ML (2006) Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections. J Hosp Infect. 63(2): 117–23. doi: 10.1016/j.jhin.2005.10.018
[5]
Tolkoff-Rubin NE, Rubin RH (1997) Urinary tract infection in the immunocompromised host. Lessons from kidney transplantation and the AIDS epidemic. Infect Dis Clin North Am. 11(3): 707–17. doi: 10.1016/s0891-5520(05)70381-0
[6]
Rodríguez-Ba?o J, Navarro MD, Romero L, Muniain MA, Perea EJ, et al. (2006) Clinical and molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli as a cause of nosocomial infection or colonization: implications for control. Clin Infect Dis. 42(1): 37–45. doi: 10.1086/498519
[7]
Rupp ME, Fey PD (2003) Extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae: considerations for diagnosis, prevention and drug treatment. Drugs. 63(4): 353–65. doi: 10.2165/00003495-200363040-00002
[8]
de Souza RM, Olsburgh J (2008) Urinary tract infection in the renal transplant patient. Nat Clin Pract Nephrol. 4(5): 252–64 doi: 10.1038/ncpneph0781.
[9]
Cove-Smith A, Almond MK (2007) Management of urinary tract infections in the elderly. Trends in Urology, Gynaecology & Sexual Health. 12(4): 31–34. doi: 10.1002/tre.33
[10]
Rice JC, Peng T, Kuo YF, Pendyala S, Simmons L, et al. (2006) Renal allograft injury is associated with urinary tract infection caused by Escherichia coli bearing adherence factors. Am J Transplant. 6(10): 2375–83. doi: 10.1111/j.1600-6143.2006.01471.x
[11]
Naber KG, Bergman B, Bishop MC, Bjerklund-Johansen TE, Botto H, et al. (2001) EAU guidelines for the management of urinary and male genital tract infections. Urinary Tract Infection (UTI) Working Group of the Health Care Office (HCO) of the European Association of Urology (EAU). Eur Urol. 40(5): 576–88. doi: 10.1159/000049840
[12]
Fox BC, Sollinger HW, Belzer FO, Maki DG (1990) 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. 89(3): 255–74. doi: 10.1016/0002-9343(90)90337-d
Pinheiro HS, Mituiassu AM, Carminatti M, Braga AM, Bastos MG (2010) Urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in kidney transplant patients. Transplant Proc. 42(2): 486–7 doi: 10.1016/j.transproceed.2010.02.002.
[15]
Kader AA, Kumar A (2005) Prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a general hospital. Ann Saudi Med. 25(3): 239–42.
[16]
Rodríguez-Ba?o J, Pascual A (2008) Clinical significance of extended-spectrum beta-lactamases. Expert Rev Anti Infect Ther. 6(5): 671–83 doi: 10.1586/14787210.6.5.671.
[17]
Calbo E, Romaní V, Xercavins M, Gómez L, Vidal CG, et al. (2006) Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum beta-lactamases. J Antimicrob Chemother. 57(4): 780–3. doi: 10.1093/jac/dkl035
[18]
Grover ML, Bracamonte JD, Kanodia AK, Edwards FD, Weaver AL (2009) Urinary tract infection in women over the age of 65: is age alone a marker of complication? J Am Board Fam Med. 22(3): 266–71 doi: 10.3122/jabfm.2009.03.080123.
[19]
Domann E, Hong G, Imirzalioglu C, Turschner S, Kühle J, et al. (2003) Culture-independent identification of pathogenic bacteria and polymicrobial infections in the genitourinary tract of renal transplant recipients. J Clin Microbiol. 41(12): 5500–10. doi: 10.1128/jcm.41.12.5500-5510.2003
[20]
Yilmaz E, Akalin H, Ozbey S, Kordan Y, Sinirta? M, et al. (2008) Risk factors in community-acquired/onset urinary tract infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. J Chemother. 20(5): 581–5. doi: 10.1179/joc.2008.20.5.581
[21]
Chuang P, Parikh CR, Langone A (2005) Urinary tract infections after renal transplantation: a retrospective review at two US transplant centers. Clin Transplant. 19(2): 230–5. doi: 10.1111/j.1399-0012.2005.00327.x
[22]
Abbott KC, Swanson SJ, Richter ER, Bohen EM, Agodoa LY, et al. (2004) Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis. 44(2): 353–62. doi: 10.1053/j.ajkd.2004.04.040
[23]
Ranganathan M, Akbar M, Ilham MA, Chavez R, Kumar N, et al. (2009) Infective complications associated with ureteral stents in renal transplant recipients. Transplant Proc. 41(1): 162–4 doi: 10.1016/j.transproceed.2008.10.022.
[24]
Coskun AK, Harlak A, Ozer T, Eyitilen T, Yigit T, et al. (2011) Is removal of the stent at the end of 2 weeks helpful to reduce infectious or urologic complications after renal transplantation? Transplant Proc. 43(3): 813–5 doi: 10.1016/j.transproceed.2010.11.016.
[25]
Colodner R, Rock W, Chazan B, Keller N, Guy N, et al. (2004) Risk factors for the development of extended-spectrum beta-lactamase-producing bacteria in nonhospitalized patients. Eur J Clin Microbiol Infect Dis. 23(3): 163–7. doi: 10.1007/s10096-003-1084-2
[26]
Kawecki D, Kwiatkowski A, Sawicka-Grzelak A, Durlik M, Paczek L, et al. (2011) Urinary tract infections in the early posttransplant period after kidney transplantation: etiologic agents and their susceptibility. Transplant Proc. 43(8): 2991–3 doi: 10.1016/j.transproceed.2011.09.002.
[27]
Khanna P, Abraham G, Mohamed Ali AA, Miriam PE, Mathew M, et al. (2010) Urinary tract infections in the era of newer immunosuppressant agents: a tertiary care center study. Saudi J Kidney Dis Transpl. 21(5): 876–80.
[28]
Bloom RD, Crutchlow MF (2008) New-onset diabetes mellitus in the kidney recipient: diagnosis and management strategies. Clin J Am Soc Nephrol. 3 Suppl 2S38–48 doi: 10.2215/CJN.02650707.
[29]
?z?akar ZB, Yal??nkaya F, Kavaz A, Kad?o?lu G, Elhan AH, et al. (2011) Urinary tract infections owing to ESBL-producing bacteria: microorganisms change—clinical pattern does not. Acta Paediatr. 100(8): e61–4 doi: 10.1111/j.1651-2227.2011.02262.x.
[30]
Goya N, Tanabe K, Iguchi Y, Oshima T, Yagisawa T, et al. (1997) Prevalence of urinary tract infection during outpatient follow-up after renal transplantation. Infection. 25(2): 101–5. doi: 10.1007/bf02113586
[31]
Go??biewska J, D?bska-?lizień A, Komarnicka J, Samet A, Rutkowski B (2011) Urinary tract infections in renal transplant recipients. Transplant Proc. 43(8): 2985–90 doi: 10.1016/j.transproceed.2011.07.010.
[32]
John U, Everding AS, Kuwertz-Br?king E, Bulla M, Müller-Wiefel DE, et al. (2006) High prevalence of febrile urinary tract infections after paediatric renal transplantation. Nephrol Dial Transplant. 21(11): 3269–74. doi: 10.1093/ndt/gfl464
[33]
Charfeddine K, Kharrat M, Yaich S, Jarraya F, Mkawar K, et al. (2002) Infection in kidney transplant recipients in Tunisia. Saudi J Kidney Dis Transpl. 13(2): 195–8. doi: 10.4103/1319-2442.106316
[34]
Valera B, Gentil MA, Cabello V, Fijo J, Cordero E, et al. (2006) Epidemiology of urinary infections in renal transplant recipients. Transplant Proc. 38(8): 2414–5. doi: 10.1016/j.transproceed.2006.08.018
[35]
Paterson DL, Ko WC, Von Gottberg A, Casellas JM, Mulazimoglu L, et al. (2001) Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum beta-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol. 39(6): 2206–12. doi: 10.1128/jcm.39.6.2206-2212.2001
[36]
Jacoby GA (1997) Extended-spectrum beta-lactamases and other enzymes providing resistance to oxyimino-beta-lactams. Infect Dis Clin North Am. 11(4): 875–87. doi: 10.1016/s0891-5520(05)70395-0
[37]
Patterson JE, Hardin TC, Kelly CA, Garcia RC, Jorgensen JH (2000) Association of antibiotic utilization measures and control of multiple-drug resistance in Klebsiella pneumoniae. Infect Control Hosp Epidemiol. 21(7): 455–8. doi: 10.1086/501787
[38]
Livermore DM (1995) beta-Lactamases in laboratory and clinical resistance. Clin Microbiol Rev. 8(4): 557–84.
[39]
Falagas ME, Kastoris AC, Kapaskelis AM, Karageorgopoulos DE (2010) Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum beta-lactamase producing, Enterobacteriaceae infections: a systematic review. Lancet Infect Dis. 10(1): 43–50 doi: 10.1016/S1473-3099(09)70325-1.