21/9/2020 Urinary Tract Infections in Transplant Recipients

Urinary Tract Infections in Transplant Recipients

Authors: Francisco López-Medrano and José María Aguado

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Epidemiology
Table 1: Risk Factors for UTI in Renal Transplant Recipients
Clinical Manifestations
Approach to Diagnosis Female gender
Approach to Therapy
Prophylaxis Advanced age
References
Pre-transplant UTI

Higher grade of immunosuppression

Acute rejection episodes

Impaired graft function

Postoperative bladder catheterization

Problems in ureteral anastomosis or presence of ureteral stents

Surgical manipulation of the graft

Diabetes mellitus

Pregnancy

History of vesicoureteral reflux

History of polycystic kidney disease

Cadaveric donor

Cytomegalovirus disease

Repeated episodes of asymptomatic bacteriuria as a risk factor for pyelonephritis

Schistosomiasis

Table 2 : Causal Pathogens and the Frequency of Bacteria in Lower and Upper UTI in Renal
Transplant Recipients
Etiology of
Etiology of cystitis Prevalence Prevalence
pyelonephritis
Escherichia coli 57% Escherichia coli 52%
Enterococcus faecalis 13% Pseudomonas aeruginosa 12%
Klebsiella pneumoniae 10% Klebsiella pneumoniae 8%
Streptococcus agalactiae 6% Morganella morgagni 8%
Proteus mirabilis 4% Enterococcus faecalis 8%
Klebsiella oxytoca Coagulase 4%
2%
negative Staphylococcus
Morganella morgagni 2% Enterococcus faecium 4%
Pseudomonas aeruginosa 2% Others 4%
Coagulase
1%
negative Staphylococcus
Enterococcus faecium 1%
Others 2%

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21/9/2020 Urinary Tract Infections in Transplant Recipients
Table 3: Empirical Oral Antibiotic Treatment for SOT Recipients with Lower UTI Infection
(Cystitis)a,b,c
Antibiotic Dose (mg) Interval
Trimethoprim-sulfamethoxazoled,e 160/800 q12h

Norfloxacinf 400 q12h

Ciprofloxacinf 500 q12h

Levofloxacinf 500 q24h

Cefixime 400 q24h
Nitrofurantoin 100 q6h
Amoxicillin plus clavulanate 500 q12h
aDose modification is necessary in renal failure

bRegimens of 10-14 days are preferred for SOT recipients

c Previous microbiological results of the patients should be considered. Susceptibility of the pathogen to selected antibiotic must be
confirmed with in vitro susceptibility testing of the urine sample

dNot appropriate as empirical treatment for SOT under prophylaxis with this antibiotic

eEmpirical use limited to thoseAntimicrobe.org.

geographicalNo areas where
© 2010-2011. portion of thisfrequency
site may be of resistance is less than 20%
reproduced.

fFluorquinolones should be avoided in pregnancy, nursing mothers and adolescents younger than 17 years-old

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