Spectrum and impact of urinary tract infections among adult renal allograft recipients in a tertiary care center of Northeast India.

Abstract

Background: Urinary tract infections (UTI) pose a significant threat to renal allograft recipients (RARs), jeopardizing graft function and patient survival. This study aimed to investigate the incidence, microbiological profile, risk factors, and impact of UTI on renal allograft outcomes.

Methods: A retrospective cohort study was conducted at a tertiary care center in Assam, India, from July 2022 to January 2024, including 220 RARs aged over 18 years. Detailed clinical, microbiological, and outcome data were collected and analyzed. Multivariate logistic regression was performed to identify independent risk factors.

Results: The incidence of UTI was 55/220, (25%), with a higher incidence in females 32/55 (58%). The highest incidence occurred within the first 3 months post-transplant (42.3%), followed by 4-6 months (34.6%), and beyond 6 months (23.1%). Asymptomatic bacteriuria 25/55 (45%) and cystitis (19/55 (35%) were the most common UTI types. Escherichia coli 22/55 (44%) and Klebsiella pneumoniae 18/55 (32%) were the predominant uropathogens, with 7/55 (12%) of isolates being multi-drug resistant (MDR) and 4/55 (7%) pan-drug resistant (PDR). Female gender [odds ratio (OR) 6.73, 95% confidence interval (CI) 4.53-12.65, p < 0.001)], prolonged Foley's catheterization (OR 3.92, 95% CI 2.95-4.88, p = 0.019), and urinary tract abnormalities (OR 2.83, 95% CI 1.61-4.17, p = 0.027) emerged as significant independent risk factors. UTI led to acute graft dysfunction in 54% (30/55) of cases, and 3% (2/55) underwent graft nephrectomy. However, 76% (23/30) of patients with acute graft dysfunction due to UTI achieved complete recovery with management.

Conclusions: This study on UTI in renal transplant recipients in India found a 25% incidence rate, highest within the first 3 months post-transplant. Asymptomatic bacteriuria was common, despite UTI-related graft challenges, most acute dysfunctions resolved with management. Female gender, prolonged catheterization, and urinary tract abnormalities were significant risk factors.