Valeria Ripa, Harry Sun, Matthew Rosenzweig, Matthew Hanlon, Stuart Geffner
Bacterial complications are common during the early post-transplant period and are dominated by UTI. The frequent coexistence of UTI with bacteremia and SSI, together with high microbiologic concordance between urine and blood cultures, suggests that these complications are often interconnected rather than independent events. Strategies aimed at preventing UTI may help reduce the burden of more complex post-transplant bacterial complications.
BACKGROUND: Early bacterial complications remain a major source of morbidity after kidney transplantation. We evaluated the epidemiology, microbiology, risk factors, and clinical implications of bacterial complications occurring within 60 days after kidney transplantation.
METHODS: We performed a retrospective cohort study of 365 consecutive adult kidney transplant recipients at a high-volume transplant center. Bacterial complications, microbiologic findings, risk factors, and clinical outcomes were analyzed. Multivariable logistic regression was used to identify factors independently associated with infection.
RESULTS: Within 60 days after transplantation, 166 recipients (45.5%) developed at least one bacterial infection. Urinary tract infection (UTI) was the predominant complication, occurring in 142 recipients (38.9%), followed by surgical site infection (SSI) in 34 (9.3%) and bacteremia in 30 (8.2%). The median time to first infection was postoperative day 13 (IQR 8-21). Multi-site infection occurred in 45 recipients (27.1% of infected recipients; 12.3% of the overall cohort), with UTI present in 84.4% of cases. Among recipients with bacteremia, 80.0% had a concurrent UTI, and urine and blood cultures demonstrated organism concordance in 87.5% of cases. Gram-negative organisms predominated across infection sites, with Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa among the most frequently isolated pathogens. Enterococcus faecalis was also frequently identified, particularly in urinary and surgical site cultures. On multivariable analysis, female sex (aOR 1.90, 95% CI 1.19-3.03; p = 0.007), longer pretransplant dialysis duration (aOR 1.09 per year, 95% CI 1.01-1.17; p = 0.027), and DGF (aOR 1.82, 95% CI 1.11-2.99; p = 0.018) were independently associated with bacterial complications.
CONCLUSIONS: Bacterial complications are common during the early post-transplant period and are dominated by UTI. The frequent coexistence of UTI with bacteremia and SSI, together with high microbiologic concordance between urine and blood cultures, suggests that these complications are often interconnected rather than independent events. Strategies aimed at preventing UTI may help reduce the burden of more complex post-transplant bacterial complications.