Management of Urinary Tract Infection

Abstract

Urinary tract infections are common after transplantation and the most frequent infectious complication of kidney transplant recipients. The prevalence of UTI post renal transplantation ranges from 23-85%, but this is less know for other solid organ transplants. Risk factors for UTI are similar to those described in the general population, and usually involves invasive procedures after surgery. The requirement of ureteric stents and post-transplant urinary obstruction are specific risk factors for kidney transplant patients that partially explains the high incidence of UTI in this setting. UTI are classified into lower (cystitis) and upper (pyelonephritis) tract infections according to clinical symptoms. Lower UTI are usually treated with oral antibiotics and usually has minor or absent impact in the allograft. Upper UTI require intravenous antibiotics and hospital admission in most cases and in kidney transplant patients can deteriorate the function of the allograft and patient’s survival. In kidney transplant patients, asymptomatic bacteriuria should only be treated during the first 1-2 months post-transplantation. After this period of time, monitoring urine cultures is controversial and has not shown significant benefits. Some kidney transplant patients develop recurrent UTI which usually worsen the quality of life. To decide antibiotic prophylaxis for recurrent UTI we should take into account the clinical impact of previous UTI, the kidney allograft function, antibiotic sensitivities of previous isolated uropathogens and colonization with multi-drug resistant bacteria.