Urinary tract infections in kidney transplant. Treatment duration and recurrences: a multicenter study in Argentina
Astrid A Smud1, Sergio S Andino2, Silvina S Villamandos4, Natalia N Pujato3, Melisa M Martinez5, Patricia P Giorgio6, Laura L Barcan1.
1Infectious Diseases, Hospital Italiano Buenos Aires, Caba, Argentina; 2Infectious Diseases, Fundación Favaloro, Caba, Argentina; 3Infectious Diseases, Instituto de Trasplantes y Alta Complejidad, Caba, Argentina; 4Infectious Diseases, Instituto de Cardiología de Corrientes “Juana F. Cabral “. , Corrientes, Argentina; 5Infectious Diseases, Hospital Central de Mendoza. , Mendoza, Argentina; 6Infectious Diseases, Hospital Británico, Caba, Argentina
Transplant Infectious Diseases Comission. Sociedad Argentina de Infectología. S.A. de Trasplantes.
Introduction: Urinary tract infections (UTI) are the most frequent infections in kidney transplant (KT). Optimal treatment duration and its relation to recurrence is not clear.
Objective: to analyze treatment duration in relation to recurrence of UTI.
Methods: Retrospective study, in 6 centers in Argentina. All adult KT or combined transplant including kidney that presented UTI and required admission during 2021 were included.
Results: 222 episodes (ep.) in 129 patients (pat.). Sex M 53%, Age: 48(IQR 38-60) KT: 89%, kidney-pancreas 8%, and other 3%. Deceased donor 106 patients, First transplant 91%. 32 pat. (25%) presented previous urological disorders. 80 pat. (62%) received Thymoglobulin as induction therapy, 32 (24,8%) pat. Basiliximab and 17 (13%) others. Baseline IS was tacrolimus + prednisone + mycophenolate 70%, m-TOR 12 % and other 18%.Microbiology: 126/222 (57%) bacteria were multidrug-resistant organisms (MDRO):E Coli: 95 (42% MDRO); KES: 96 (MDRO 82%), other enterobacteria: 8, Enterococcus 11 P. aeruginosa: 6; Acinetobacter 3, Candida 2. Most frequent symptoms were fever alone 24%, and fever plus increased creatinine levels 14.5%. Recurrence occurred in 38% pat. Recurrence was not related to: type of donor p= ns , previous urological disorder: p= 0.14, surgical complication: p=0.6, previous urinary tract instrumentation: p=0.079, rejection: p=0.158, MDRO: p=0.09, Carbapenemase: p=0.37, adequate empirical treatment: p=0.71, acute pyelonephritis in biopsy: p=ns. Bacteremia was the only variable related to recurrence (yes: 21/51 ep. (41%) , no: 42/169 (25%) p=0.023 (1.65. 1.08-2.52). Recurrences were also not related to antibiotic treatment duration in our whole population: 35% of pat. who had no recurrence received ≤7 days as well as 31% of those pat. who had recurrence. P=ns. Subgroup analysis according to risk factors like urological disorder, surgical complications, etc was not possible in this cohort because of few pat. in each group.
| Previous ATB duration (days) | n | ≤ 7 d. | 8-10 d | 11-14 | > 14 |
| 2° ep. | 49 | 31% | 18% | 47% | 4% |
| 3° ep. | 25 | 24% | 24% | 48% | 4% |
| 4° ep. | 9 | 0 | 33.5% | 44.5% | 22% |
| 5° ep. | 6 | 17% | 50% | 0 | 33% |
| 6° ep. | 2 | 0 | 0 | 100% | 0 |
| 1° ep. without recurrence | 80 | 35% | 25% | 31% |
9% |
Conclusions: In this study, recurrence UTI was not related to treatment duration , but our n is too small to assert that correlation , even more among subgroups with different risk factors for recurrence. Due to the importance of antibiotic treatment duration in relation to antimicrobial resistance, it is mandatory to define the optimal treatment duration for UTIs in KT. Our group continues to enroll patients to achieve reliable information.
