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PSEUDOMONAS URINARY TRACT INFECTIONS IN RENAL TRANSPLANT
RECIPIENTS-A SINGLE CENTRE OBSERVATIONAL STUDY
INTRODUCTION
Urinary tract infections (UTIs) are the most common infectious complication following renal
transplantation. Pseudomonas is a resistant organism which is more common in Nosocomial
UTIs. Studies quoted in the literature disagree on the risk factors associated with developing
UTIs post-transplant and on the effect that UTIs may have on graft outcomes and patient
morbidity. We performed a retrospective cohort study on Pseudomonas UTIs in adult renal
transplant recipients with an objective to look into associated risk factors, graft outcomes and
morbidity.
METHODOLOGY
A list of all Pseudomonas UTI episodes in renal transplant recipients from January 2010 to
December 2014 was collected from the Microbiology coding department in our hospital. We
identified 74 episodes of Pseudomonas UTIs which occurred in 39 patients. Data was
retrospectively collected from the medical notes and was analysed.
RESULTS
The mean age of our sample was 54 and 67% of patients were male. 30% of patients had a
urological cause of primary kidney failure (including reflux nephropathy and chronic
pyelonephritis). 28 patients had one episode, 6 had 2 episodes and 5 had more than three
episodes of Pseudomonas UTI in this time period.54% of patients had UTIs in the first year
post-transplant. One third (13) had their ureteric stent at the time of UTI. 8 out of 39 patients
had an indwelling urinary catheter.23% had an associated viral infection with CMV/EBV or
BK. There were no rejection episodes in our cohort. The majority of patients (69%) were only
on double immunosuppression (Tacrolimus+Myfortic). 50% needed hospital admission for
Intravenous (IV) antibiotics. Common antibiotics sensitivities were Ciprofloxacin, Tazocin and
Gentamycin. Even with standard treatment 59% had positive repeat urine cultures needing an
extended course or alternate antibiotics.21% of patients went onto long term prophylactic
antibiotics.30% of patients had AKI due to the UTI episode and 25% of these patients had a
raised creatinine more than 40 micromol/L at 1 year follow up without any other obvious
cause.
CONCLUSIONS
Pseudomonas UTIs are associated with an increased morbidity risk in renal transplant
recipients. High risk groups include patients with reflux nephropathy and chronic
pyelonephritis as their primary disease. The prevention of UTIs in high-risk renal transplant
patients involves planning early removal of catheters & stents and consideration of antibiotic
prophylaxis. This may lead to a reduced post-transplant morbidity and improve graft outcomes.