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Table of Contents
REVIEW ARTICLE
Year : 2022  |  Volume : 16  |  Issue : 5  |  Page : 82-88

Expert group opinion for urinary tract infection in solid organ transplant recipients in South Asia


1 Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
2 Department of Nephrology and Renal Transplant Medicine, Medanta Kidney and Urology Institute, Medanta Medicity, Gurugram, Haryana, India

Date of Submission29-Oct-2021
Date of Acceptance14-Feb-2022
Date of Web Publication18-Oct-2022

Correspondence Address:
Dr. Sishir Gang
Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad - 387 001, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijot.ijot_110_21

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  Abstract 


Urinary tract infection (UTI) is one of the common infections in solid organ transplant recipients and the most common infection in kidney transplant recipients. UTI in the early posttransplant period is associated with significant morbidity and graft dysfunction. Female gender, advanced age, presence of urinary tract abnormalities, and diabetes mellitus are some of the risk factors for UTI. The emergence of multi-drug resistant bacteria has made the treatment difficult and one needs to be aware of the local antibiotic resistance pattern when treating empirically. These patients should be treated adequately and those with recurrent UTI would need long-term prophylaxis. Asymptomatic bacteriuria should only be treated if it occurs within the first 2–3 months of transplant, otherwise, it can lead to the emergence of the resistant organism without any benefit. To reduce the risk of UTI after transplant, the Foley's catheter should be removed within 3–5 days, DJ stent should be removed within 2–3 weeks and the recipient should be kept on routine prophylaxis for 6 months.

Keywords: Kidney transplant, solid organ transplant, South Asia, urinary tract infection


How to cite this article:
Gang S, Rana A, Bansal SB. Expert group opinion for urinary tract infection in solid organ transplant recipients in South Asia. Indian J Transplant 2022;16, Suppl S1:82-8

How to cite this URL:
Gang S, Rana A, Bansal SB. Expert group opinion for urinary tract infection in solid organ transplant recipients in South Asia. Indian J Transplant [serial online] 2022 [cited 2022 Dec 9];16, Suppl S1:82-8. Available from: https://www.ijtonline.in/text.asp?2022/16/5/82/358657




  Introduction Top


Urinary tract infection (UTI) is a common infection in solid organ transplant (SOT) recipients and the most frequent infectious complication in kidney transplant recipients (KTRs).[1],[2] UTI continues to be the major cause of morbidity and graft dysfunction in the early postoperative period.[3],[4] In the multicenter RESITRA registry, the incidence of bacterial UTIper 100 transplantation-days was 4.5 for kidney, 2.2 for kidney-pancreas, 0.6 for liver, 0.7 for heart, and 0.2 for lung transplant recipients.[2] In view of the emergence of antibiotic-resistant organisms, it is desirable to develop strategies for the prevention and appropriate treatment of this infection. This review will provide current knowledge about epidemiology, risk factors, treatment and prevention of UTI in SOT recipients with particular emphasis on KTRs.


  Definitions Top


The definition of UTI in SOT recipients is similar to those in the general population. However, all symptomatic UTI whether lower or upper tract is considered complicated UTI. The definitions provided in [Table 1] are adapted from reference.[5]
Table 1: Diagnostic criteria for urinary tract infection

Click here to view



  Epidemiology Top


The reported incidence of UTI infection in KT recipients varies from 23% to 75%.[5] This wide variation is probably due to non-uniform diagnostic criteria, different antibiotic prophylaxis regimens, varying duration of follow-up, immunosuppressive regimen, and clustering of infections due to local outbreaks. About 30% of all hospitalizations for sepsis in KTRs are due to UTI[6] of which 80% occur within the first 3 months and are associated with poor graft function.[7] Late infections are more frequent in women compared to men. The prevalence of recurrent UTIs varies from 4% to 10%.[1] Two recent studies from North and South India showed UTI prevalence of 32.86% and 41.9%, respectively, among KTR.[8],[9]


  Risk Factor for Urinary Tract Infection Top


The risk factors for the development of post-transplant UTI in SOT recipients are multifactorial and are determined by the interaction between host factors, pathologic agents, anatomical abnormalities, pre-transplant patient characteristics, the donor source, peri-operative need for catheterization, and immunosuppression. The risk factors for UTI can be classified into pretransplant and post-transplant and are listed in [Table 2]. Both female gender and advanced age are suggested to be risk factors for UTI in pre- and posttransplant period, however, there are conflicting data about it.[10],[11] Diabetes mellitus is not only associated with bacterial infection but is also an important risk factor for Candida albicans infection.[1]
Table 2: Risk factors for urinary tract infection in renal transplant recipient

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The other pretransplant risk factor for posttransplant UTI are recurrent UTI before transplant, urological abnormalities in the recipient, and polycystic kidney diseases.[1]

Deceased donor and use of expanded criteria donor are risk factors found to be associated with increased risk of UTI. In KTRs, unlike native ureters, the transplant ureter is short and often refluxing. This increases the risk of pyelonephritis. Prolonged bladder catheterization, problems in the ureteral anastomosis, and ureteral stenting for a period greater than 4 weeks is associated with increased risk of UTI, hence early removal is recommended.[12]

Apart from recipient characteristics and peri-operative factors, the dose and type of immunosuppression also determine the risk of UTI. The use of mycophenolate mofetil and anti-thymocyte globulin has been found to be associated with increased risk of UTI.[7],[10] Episodes of delayed graft function or rejection and need for additional immunosuppression also predispose to UTI.[13] Serum creatinine levels >2 mg/dL and prednisone dose >20 mg/d are considered risk factors for late UTI (>6 months post-transplantation).[14]


  Microbiology Top


Gram-negative organisms are the predominant cause of UTI in KTRs. Escherichia coli is the most common organism followed by Klebseilla pneumonia, Pseudomonasaeruginosa, Enterococcus, Enterobacter cloacae, and Proteus sp.[15] Gram-positive bacteria such as Staphylococcus saprophyticus, Streptococcus species, and Corynebacteriumurealyticum can occasionally cause UTIs.[16] In a study by Hase et al., the most common organism isolated for complicated UTI from a single center from India was E. coli (53%) followed by Klebsiella pneumoniae (24.40%), Enterococcus (12.24%), Pseudomonas (4.08%), candida in two (4.08%), and Proteus (2%).[17]

C. albicans is the predominant fungus responsible for UTI in KT recipients, most notably in diabetic recipients. Candiduria though frequent is often asymptomatic, however rarely it causes ascending infection, obstruction due to fungal balls and candidemia.[18]

BK virus (BKV) is an important pathogen in KT recipients but largely remains asymptomatic except in the setting of ureteral stenosis. Although BKV associated hemorrhagic cystitis is well-described in hematopoietic stem cell transplant recipients, this is relatively uncommon in KT recipients.[19]

In the last decade, with the widespread use of antibiotics in the community and hospital setting there has been an increased incidence of multi-drug resistance bacteria in transplant patients. In the Spanish registry study RESTIRA, 26% of symptomatic E. coli infections were caused by ESBL (Extended Spectrum Beta Lactamases)-producing organisms.[2] The study from Brazil also shows 45% incidence of ESBL-producing organisms, especially in those with recurrent UTI.[20] Similar study in complicated UTIs from India revealed 58% of isolates were ESBL producers, whereas 4% were pan resistant.[17] Recent meta-analysis by Michail has shown that one in ten transplant patients will develop UTI with ESBL-producing organism with increased risk of recurrence.[21] There are several reports of Carbapenem-resistant Klebsiella pneumonia UTI in SOT. They are not only associated with recurrent UTIs but are also often the cause of mortality.[22],[23]


  Clinical Manifestations Top


Clinical presentation can vary from asymptomatic bacteriuria (AB) to complicated acute pyelonephritis.

AB is the presence of > 105 bacterial colony-forming units per milliliter (CFU/mL) in the urine without urinary or systemic symptoms which mostly signifies contamination or colonization.

Simple cystitis is positive urine culture (>103 CFU/ml) and lower urinary symptoms such as dysuria, frequency, or urgency but no systemic symptoms and no indwelling device. Complicated UTI/pyelonephritis includes significant growth of a uropathogen (104 CFU/ml) and at least one of the following: fever, chills, graft tenderness, hemodynamic instability, leukocytosis, or evidence of bacteremia with the same organism as in the urine culture or associated prostatitis. UTIs associated with structural or functional abnormalities of the genitourinary tract, indwelling ureteric stents, bladder catheters, or nephrostomy tubes are also included in complicated UTIs. All patients with any systemic symptoms are classified as complicated UTIs. Recurrent UTI includes ≥3 UTIs (/reinfection/relapse) in the prior 12-month period.[5]

In general, these UTIs are associated with >10WBCs/mm3 in urine but <10 WBCs does not rule out UTI. It is important to note that signs and symptoms of UTIs may be subtle in transplant recipients due to the immunosuppressants and being a denervated graft. Hence, a thorough clinical and laboratory evaluation is needed and any new febrile illness with asymptomatic rise of creatinine should prompt a search for UTI, even in absence of urinary tract specific symptoms [Table 1].


  Diagnosis of Urinary Tract Infection Top


Specimen collection

Definitive diagnosis of UTI requires microbiological confirmation by urine culture. Midstream urine specimen should be obtained, after cleaning the perineum/glans with antiseptic wipes, in a sterile container. In patients unable to provide midstream specimen, straight catheterization for obtaining urine specimen is also an appropriate option. For patients with short-term indwelling catheters, the sample should be obtained by puncturing the catheter port. For the patient with long-term indwelling catheter, a midstream urine sample should be obtained after removing the catheter or from the newly placed catheter.[1]


  Screening Top


Though many transplant centers routinely screen for the presence of AB, the data supporting the benefit of this practice is uncertain.[2] If screening is undertaken, it should be limited to the first three months following the kidney transplant. This will avoid unnecessary treatment and selection of drug-resistant bacteria. The American Society of Transplantation Infectious Diseases Community of Practice advises not to treat ASB occurring more than 3 months after KT unless there is an increase in serum creatinine. Most centers recommend screening for ASB every 2–4 weeks till 12 weeks posttransplant.[5]


  Diagnosis Top


The standard quantitative criterion for the diagnosis of UTI with voided specimens is an organism count of ≥105 CFU/mL of a potential uro-pathogen. In patients with UTI, pyuria should be present on urine microscopy. A Patient with UTI should undergo appropriate imaging studies. Ultrasound or noncontrast computed tomography (CT) scan should be done to rule out any structural abnormalities. Uroflowmetry and in men trans-rectal sonography should be done to rule out outflow obstruction.

Recommendations

  • Urine culture collection technique is important. A midstream urine sample is collected in a sterile container after the use of antiseptic wipes to clean the perineum/glans
  • In patients unable to perform these steps, straight catheterization to obtain a urine specimen can be considered. For patients with indwelling catheters (>2 weeks), the sample should be obtained from after removing the catheter or after inserting the new catheter
  • Transplant patients should not be screened for AB
  • For diagnosis of UTI, urine culture should be positive with >105 CFU/ml with pyuria in urine analysis
  • UTI in a transplant patient requires appropriate imaging studies/uroflowmetry to rule out structural abnormality.



  Treatment of Urinary Tract Infection Top


Treatment of UTI in posttransplant period depends on the symptomatology, duration after transplantation, site, and severity of infection. However, it must be borne in mind that in view of the immunosuppressed state the correlation between symptoms, signs, and effect on graft function may be poor. The choice of anti-bacterial treatment is guided by the local epidemiology, culture, and sensitivity of the infecting organism. In patient with sepsis, reduction or discontinuation of anti-proliferative immunosuppression should be considered. Imaging studies (ultrasound/CT scan/transrectal sonography) and uroflowmetry should be done to determine any structural or functional abnormality of the urogenital system.


  Asymptomatic Bacteriuria Top


AB is common after kidney transplant. It was believed, albeit with limited evidence that it is a risk factor for progression to UTI, graft pyelonephritis, graft dysfunction, and graft loss.[24]

Two recent prospective studies did not show any benefit of treating AB.[25],[26] Among the retrospective studies the outcome has been mixed. Some report possible benefits and some report either no benefit or possible harm in form of selecting drug-resistant strains.[27],[28],[29],[30],[31]

Most trials have excluded patients in the first 1 to 3 months following kidney transplant. In view of inadequate data and theoretical concerns about progression to symptomatic UTI or graft dysfunction, it may be prudent to treat AB in the early months following transplantation, especially if they are associated with pyuria. After 3 months it is not recommended to screen for or treat AB. Treating such patients risks the selection and emergence of more resistant organisms, however an exception can be made for the treatment of persistent ASB in patients with, who develop impairment of renal function due to the rare occurrence of asymptomatic pyelonephritis.[32]


  Symptomatic Urinary Tract Infection Top


Urine analysis, urine, and blood cultures should be drawn to determine antibiotic susceptibility, before the administration of antibiotics. Urinary catheters should be preferably removed or changed. Ultrasound of the graft and native kidney should be done to rule out structural abnormalities and asses post void residue. Choice of empiric antibiotics should be based on the local epidemiology of resistance and prior susceptibilities in previous episodes of UTI. Once the antibiotic susceptibilities are known, the therapy should be de-escalated to the narrowest spectrum.

For patients with cystitis and no evidence of systemic effects such as fever, leukocytosis, allograft tenderness, or graft dysfunction, an oral antibiotic is suitable. Either oral fluoroquinolone, oral third-generation cephalosporin, nitrofurantoin are appropriate choices. The duration of treatment should be 7–10 days. Single-dose or short course of 3 days is not preferred. In view of increasing resistance to the above medications, oral fosfomycin (3-gram powder of fosfomycin dissolved in a glass of water), two or three doses given 48 h apart is preferred by many transplant physicians. However, in view of limited oral options and increasing resistance fosfomycin should be used only if other options are not available.[27],[28],[32],[33]

For patients with severe infection, the initial choice of antibiotics is intravenous third-generation cephalosporin (cefaperazone, ceftazidime) or piperacillin/tazobactam or a carbapenem (meropenem or doripenem).

Further, the incidence of multi-drug resistant UTIs is growing. They are associated with increased mortality, graft failure, and recurrence.[23],[34] For these patients, a combination therapy is indicated. A regimen combining a carbapenem plus one or two fully active drugs (including colistin, an aminoglycoside, or fosfomycin) is recommended if carbapenem minimum inhibitory concentration (MIC) is <8 mg/L.[35] Carbapenems are not recommended if the MIC is >16 mg/L. Between 8 and 16, the role of carbapenem is uncertain.[36]


  Recurrent Urinary Tract Infection Top


Thorough evaluation should be undertaken to rule out any structural or functional abnormality of the urinary tract [Figure 1].[15] Prostate and native kidney as a source of infection should also be considered. In patients with autosomal dominant kidney disease, PET scans may be done to look for infected cysts.
Figure 1: Evaluation of recurrent urinary tract infection in kidney transplant recipient

Click here to view


Both urine and blood cultures should be drawn. Intravenous third-generation cephalosporin or carbapenem should be initiated. The choice may take into consideration the bacteriology and susceptibility of the previous episode. The duration of antibiotics is uncertain but many experts believe that a course of 4–6 weeks should be administered.

To prevent recurrent UTI in women they should be counseled about frequent voiding, adequate hydration and to void after sexual intercourse.

Consideration may be given to use low-dose nitrofurantoin or trimethoprim for long-term prophylaxis. Attempts should be made to stop and observe for relapse after 3–6 months. Long-term prophylaxis is required in many patients as stoppage is associated with relapse.

Recommendations

  • AB in transplant recipients should not be treated after 3 months posttransplant
  • Choice of empiric antibiotics for treatment of UTI should be based on the local epidemiology of resistance and prior susceptibilities in previous episodes of UTI. Once the antibiotic susceptibilities are known, the therapy should be de-escalated to the narrowest spectrum
  • Patients with cystitis only should be treated with oral antibiotics for 7–10 days
  • Patients with pyelonephritis/complicated UTI need intravenous treatment for 2–3 weeks
  • For multidrug-resistant UTI, regimen combining a carbapenem plus one or two fully active drugs (including colistin, an aminoglycoside, or fosfomycin) is recommended
  • Patients with recurrent UTI need a thorough evaluation for lower urinary tract to rule out any structural/functional abnormality
  • A longer 4–6 weeks course of antibiotics can be considered in patients with recurrent UTI. Consideration may be given to use low dose nitrofurantoin or trimethoprim for long term prophylaxis



  Prevention of Urinary Tract Infection Top


Urinary catheter

Longer the duration of urinary catheterization higher the incidence of UTI.[1] Early removal of the urinary catheter within 3–5 days has been associated with reduced rates of early UTI.[37],[38],[39] Antibiotic administration before catheter removal may help to reduce the rate of UTI.[40]

Ureteric stent

Meta-analysis of randomized control trials recommends the routine use of a prophylactic transplant ureteric stent to reduce major urological complications, although at a slightly higher risk of UTI infection. Early removal, within 2 weeks, may mitigate this problem to some extent.[12]


  Prophylactic Antibiotics Top


Trimethoprim/sulfamethaxazole (TMP) SMX) which is recommended as prophylaxis against Pneumocystis jirovecii pneumonia for the first 6–12 months, is also helpful to prevent UTI.[41] However, its role is uncertain now with widespread resistance to TMP/SMX. Nitrofurantoin or ciprofloxacin may be considered if the patient is allergic to TMP/SMX. The use of long-term prophylaxis was found to be useful in one study,[42] however it is not supported by others due to fear of the increased risk of resistance and is not recommended at present.[1]


  Screening for Urinary Tract Infection in Transplant Candidates and Donors Top


A thorough history of urinary complaints such as dysuria, double voiding, straining, incomplete voiding, fever, history of previous urological procedures should be sought from the recipients. Urine routine, culture, and an ultrasound KUB are done in all prospective transplant recipients and donors before taking for surgery. Any symptomatic episode of UTI should be adequately treated in donor or recipient before taking them for surgery. Recipients without any previous history of UTI, normal urine examination, and normal imaging require no further work-up. Patients with a history of UTI, abnormal USG (dilated ureter, kidney stones, bladder abnormalities) should be further evaluated with noncontrast/contrast CT of KUB for stone and hydronephrosis, micturating cystourethrogram in case of dilated ureters or abnormal bladder to rule out reflux/urethral stricture/posterior urethral valve. An uroflow and bladder scan should be done in patients with a history of long-standing diabetes or if suspicion of neurogenic bladder, however sometimes it might not be possible due to small urine output, then one might need urodynamic studies to know the status of the bladder.

Recommendations

  • Early urinary catheter removal, i. e., within 3–5 days posttransplant and early ureteric stent removal, i. e., within 2–3 weeks should be considered to decrease the chances of posttransplant UTI
  • TMP/SMX prophylaxis first 6–12 months posttransplant might help reduce the incidence of early posttransplant UTI. Nitrofurantoin or ciprofloxacin may be considered if the patient is allergic to TMP/SMX.



  Conclusions Top


UTI is a common infection in SOT recipients and is the most frequent bacterial complication following kidney transplantation. It is associated with significant morbidity and has an impact on graft function. Early in the transplant period, AB may be treated, however, it is not recommended to screen or treat AB after 3 months of transplantation. Symptomatic UTI should be promptly treated with narrow-spectrum culture-sensitive antibiotics. Multidrug-resistant organism requires combination therapy. Thorough evaluation should be undertaken in patient with recurrent infection for structural or functional abnormality of the urinary tract. Preventive strategies, especially reducing the duration of indwelling tubes are important to prevent UTIs. There are still many controversial issues in posttransplant UTI and future research should be directed to see any benefit of long-term prophylaxis, follow-up of AB, use of combination therapy for MDR UTI, and role of the urinary microbiota in relation to UTI.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Alangaden GJ, Thyagarajan R, Gruber SA, Morawski K, Garnick J, El-Amm JM, et al. Infectious complications after kidney transplantation: Current epidemiology and associated risk factors. Clin Transplant 2006;20:401-9.  Back to cited text no. 1
    
2.
Vidal E, Torre-Cisneros J, Blanes M, Montejo M, Cervera C, Aguado JM, et al. Bacterial urinary tract infection after solid organ transplantation in the RESITRA cohort. Transpl Infect Dis 2012;14:595-603.  Back to cited text no. 2
    
3.
Pelle G, Vimont S, Levy P, Hertig A, Ouali N, Chassin C, et al. Acute pyelonephritis represents a risk factor impairing long-term kidney graft function. Am J Transplant 2007;7:899-907.  Back to cited text no. 3
    
4.
Silva M Jr., Marra AR, Pereira CA, Medina-Pestana JO, Camargo LF. Bloodstream infection after kidney transplantation: Epidemiology, microbiology, associated risk factors, and outcome. Transplantation 2010;90:581-7.  Back to cited text no. 4
    
5.
Parasuraman R, Julian K; AST Infectious Diseases Community of Practice. Urinary tract infections in solid organ transplantation. Am J Transplant 2013;13 Suppl 4:327-36.  Back to cited text no. 5
    
6.
Abbott KC, Oliver JD 3rd, Hypolite I, Lepler LL, Kirk AD, Ko CW, et al. Hospitalizations for bacterial septicemia after renal transplantation in the united states. Am J Nephrol 2001;21:120-7.  Back to cited text no. 6
    
7.
Alangaden GJ. Urinary tract infections in renal transplant recipients. Curr Infect Dis Rep 2007;9:475-9.  Back to cited text no. 7
    
8.
Mukherjee D, Sharma S, Nair RK, Datt B, Arora D, Rao A. Urinary tract infection in renal transplant recipients at a tertiary care center in India. Saudi J Kidney Dis Transpl 2018;29:361-8.  Back to cited text no. 8
[PUBMED]  [Full text]  
9.
Mohan MV, Neeraja M, Sudhaharan S, Raju SB, Gangadhar T, Lakshmi V. Risk factors for urinary tract infections in renal allograft recipients: Experience of a tertiary care center in Hyderabad, South India. Indian J Nephrol 2017;27:372-6.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: A retrospective review at two US transplant centers. Clin Transplant 2005;19:230-5.  Back to cited text no. 10
    
11.
Meier-Kriesche HU, Ojo A, Hanson J, Cibrik D, Lake K, Agodoa LY, et al. Increased immunosuppressive vulnerability in elderly renal transplant recipients. Transplantation 2000;69:885-9.  Back to cited text no. 11
    
12.
Wilson CH, Bhatti AB, Rix DA, Manas DM. Routine intraoperative ureteric stenting for kidney transplant recipients. Cochrane Database Syst Rev 2005;19:CD004925.  Back to cited text no. 12
    
13.
Kamath NS, John GT, Neelakantan N, Kirubakaran MG, Jacob CK. Acute graft pyelonephritis following renal transplantation. Transpl Infect Dis 2006;8:140-7.  Back to cited text no. 13
    
14.
Muñoz P. Management of urinary tract infections and lymphocele in renal transplant recipients. Clin Infect Dis 2001;33 Suppl 1:S53-7.  Back to cited text no. 14
    
15.
Säemann M, Hörl WH. Urinary tract infection in renal transplant recipients. Eur J Clin Invest 2008;38 Suppl 2:58-65.  Back to cited text no. 15
    
16.
López-Medrano F, García-Bravo M, Morales J, Andrés A, San Juan R, Lizasoain M, et al. Urinary tract infection due to Corynebacterium urealyticum in kidney transplant recipients: an underdiagnosed etiology for obstructive uropathy and graft dysfunction – Results of a prospective cohort study. Clin Infect Dis 2008;46:825-30.  Back to cited text no. 16
    
17.
Hase AN, Bansal SB, Gadde AB, Nandwani A. Microbiological spectrum and outcomes of acute pyelonephritis in north Indian population. Saudi J Kidney Dis Transpl 2021;32:209-17.  Back to cited text no. 17
[PUBMED]  [Full text]  
18.
Denis B, Chopin D, Piron P, Resche-Rigon M, Bretagne S, Gits-Muselli M, et al. Candiduria in kidney transplant recipients: Is antifungal therapy useful? Mycoses 2018;61:298-304.  Back to cited text no. 18
    
19.
Kamal M, Govil A, Anand M, Abu Jawdeh BG, Shah S. Severe BK polyomavirus-induced hemorrhagic cystitis in a kidney transplant recipient with the absence of renal allograft involvement. Transpl Infect Dis 2018;20:e12814.  Back to cited text no. 19
    
20.
Pinheiro HS, Mituiassu AM, Carminatti M, Braga AM, Bastos MG. Urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in kidney transplant patients. Transplant Proc 2010;42:486-7.  Back to cited text no. 20
    
21.
Alevizakos M, Kallias A, Flokas ME, Mylonakis E. Colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae in solid organ transplantation: A meta-analysis and review. Transpl Infect Dis 2017;19:e12718.  Back to cited text no. 21
    
22.
Simkins J, Muggia V, Cohen H, Minamoto G. Carbapenem-resistant Klebsiella pneumoniae infections in kidney transplant recipients: A case-control study. Transpl Infect Dis 2014;16:775-82.  Back to cited text no. 22
    
23.
Bodro M, Sanclemente G, Lipperheide I, Allali M, Marco F, Bosch J, et al. Impact of antibiotic resistance on the development of recurrent and relapsing symptomatic urinary tract infection in kidney recipients. Am J Transplant 2015;15:1021-7.  Back to cited text no. 23
    
24.
Fiorante S, López-Medrano F, Lizasoain M, Lalueza A, Juan RS, Andrés A, et al. Systematic screening and treatment of asymptomatic bacteriuria in renal transplant recipients. Kidney Int 2010;78:774-81.  Back to cited text no. 24
    
25.
Origüen J, López-Medrano F, Fernández-Ruiz M, Polanco N, Gutiérrez E, González E, et al. Should asymptomatic bacteriuria be systematically treated in kidney transplant recipients? Results from a randomized controlled trial. Am J Transplant 2016;16:2943-53.  Back to cited text no. 25
    
26.
Moradi M, Abbasi M, Moradi A, Boskabadi A, Jalali A. Effect of antibiotic therapy on asymptomatic bacteriuria in kidney transplant recipients. Urol J 2005;2:32-5.  Back to cited text no. 26
    
27.
Kotagiri P, Chembolli D, Ryan J, Hughes PD, Toussaint ND. Urinary tract infections in the first year post-kidney transplantation: Potential benefits of treating Asymptomatic bacteriuria. Transplant Proc 2017;49:2070-5.  Back to cited text no. 27
    
28.
Lee JR, Bang H, Dadhania D, Hartono C, Aull MJ, Satlin M, et al. Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection: A single-center report of 1166 kidney allograft recipients. Transplantation 2013;96:732-8.  Back to cited text no. 28
    
29.
Arencibia N, Agüera ML, Rodelo C, López I, Sánchez-Agesta M, Hurtarte A, et al. Short-term outcome of untreated versus treated asymptomatic bacteriuria in renal transplant patients. Transplant Proc 2016;48:2941-3.  Back to cited text no. 29
    
30.
Green H, Rahamimov R, Goldberg E, Leibovici L, Gafter U, Bishara J, et al. Consequences of treated versus untreated asymptomatic bacteriuria in the first year following kidney transplantation: Retrospective observational study. Eur J Clin Microbiol Infect Dis 2013;32:127-31.  Back to cited text no. 30
    
31.
El Amari EB, Hadaya K, Bühler L, Berney T, Rohner P, Martin PY, et al. Outcome of treated and untreated asymptomatic bacteriuria in renal transplant recipients. Nephrol Dial Transplant 2011;26:4109-14.  Back to cited text no. 31
    
32.
Goldman JD, Julian K. Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation infectious diseases community of practice. Clin Transplant 2019;33:e13507.  Back to cited text no. 32
    
33.
López-Medrano F, Silva JT, Fernández-Ruiz M, Vidal E, Origüen J, Calvo-Cano A, et al. Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients – Results of a Spanish multicenter cohort. Am J Transplant 2020;20:451-62.  Back to cited text no. 33
    
34.
Linares L, Cervera C, Hoyo I, Sanclemente G, Marco F, Cofán F, et al. Klebsiella pneumoniae infection in solid organ transplant recipients: Epidemiology and antibiotic resistance. Transplant Proc 2010;42:2941-3.  Back to cited text no. 34
    
35.
Cervera C, Van Delden C, Gavaldà J, Welte T, Akova M, Carratalà J, et al. Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect 2014;20 Suppl 7:49-73.  Back to cited text no. 35
    
36.
Vidal E, Cervera C, Cordero E, Armiñanzas C, Carratalá J, Cisneros JM, et al. Management of urinary tract infection in solid organ transplant recipients: Consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infec Microbiol Clin 2015;33:679.e1-21.  Back to cited text no. 36
    
37.
Patel P, Rebollo-Mesa I, Ryan E, Sinha MD, Marks SD, Banga N, et al. Prophylactic ureteric stents in renal transplant recipients: A multicenter randomized controlled trial of early versus late removal. Am J Transplant 2017;17:2129-38.  Back to cited text no. 37
    
38.
Cole T, Hakim J, Shapiro R, Kayler LK. Early urethral (Foley) catheter removal positively affects length of stay after renal transplantation. Transplantation 2007;83:995-6.  Back to cited text no. 38
    
39.
Glazer ES, Benedict K, Akhavanheidari M, James S, Molmenti E. Living donor renal transplant recipients tolerate early removal of bladder catheters. Int J Angiol 2009;18:67-8.  Back to cited text no. 39
    
40.
Wolters HH, Palmes D, Lordugin E, Bahde R, Senninger N, Hölzen JP, et al. Antibiotic prophylaxis at urinary catheter removal prevents urinary tract infection after kidney transplantation. Transplant Proc 2014;46:3463-5.  Back to cited text no. 40
    
41.
Green H, Rahamimov R, Gafter U, Leibovitci L, Paul M. Antibiotic prophylaxis for urinary tract infections in renal transplant recipients: A systematic review and meta-analysis. Transpl Infect Dis 2011;13:441-7.  Back to cited text no. 41
    
42.
Horwedel T, Bowman L, Saab G, Brennan D. Benefits of sulfamethoxazole-trimethoprim prophylaxis on rates of sepsis after kidney transplant. Transpl Infect Dis 2014;16:261-9.  Back to cited text no. 42
    


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Abstract
Introduction
Definitions
Epidemiology
Risk Factor for ...
Microbiology
Clinical Manifes...
Diagnosis of Uri...
Screening
Diagnosis
Treatment of Uri...
Asymptomatic Bac...
Symptomatic Urin...
Recurrent Urinar...
Prevention of Ur...
Prophylactic Ant...
Screening for Ur...
Conclusions
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