Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection

A single-center report of 1166 kidney allograft recipients

John R. Lee, Heejung Bang, Darshana Dadhania, Choli Hartono, Meredith J. Aull, Michael Satlin, Phyllis August, Manikkam Suthanthiran, Thangamani Muthukumar

Research output: Contribution to journalArticle

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Abstract

Background: Urinary tract infection (UTI) is a frequent, serious complication in kidney allograft recipients. Methods: We reviewed the records of 1166 kidney allograft recipients who received their allografts at our institution between January 2005 and December 2010 and determined the incidence of UTI during the first 3 months after transplantation (early UTI). We used Cox proportional hazards models to determine the risk factors for early UTI and whether early UTI was an independent risk factor for subsequent bacteremia or acute cellular rejection (ACR). Results: UTI, defined as 105 or more bacterial colony-forming units/mL urine, developed in 247 (21%) of the 1166 recipients. Independent risk factors for the first episode of UTI were female gender (hazard ratio [HR], 2.9; 95% confidence intervals [CI], 2.2-3.7; P<0.001), prolonged use of Foley catheter (HR, 3.9; 95% CI, 2.8-5.4; P <0.001), ureteral stent (HR, 1.4; 95% CI, 1.1-1.8; P=0.01), age (HR, 1.1; 95% CI, 1.0-1.2; P=0.03), and delayed graft function (HR, 1.4; 95% CI, 1.0-1.9; P=0.06). Trimethoprim/sulfamethoxazole prophylaxis was associated with a reduced risk of UTI (HR, 0.6; 95% CI, 0.3-0.9; P=0.02). UTI was an independent risk factor for subsequent bacteremia (HR, 2.4; 95% CI, 1.2-4.8; P=0.01). Untreated UTI, but not treated UTI, was associated with an increased risk of ACR (HR, 2.8; 95% CI, 1.3-6.2; P=0.01). Conclusions: Female gender, prolonged use of Foley catheter, ureteral stent, age, and delayed graft function are independent risk factors for early UTI. UTI is independently associated with the development of bacteremia, and untreated UTI is associated with subsequent ACR.

Original languageEnglish
Pages (from-to)732-738
Number of pages7
JournalTransplantation
Volume96
Issue number8
DOIs
Publication statusPublished - 27 Oct 2013
Externally publishedYes

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Bacteremia
Urinary Tract Infections
Allografts
Kidney
Confidence Intervals
Delayed Graft Function
Stents
Urinary Catheters
Sulfamethoxazole Drug Combination Trimethoprim
Proportional Hazards Models
Stem Cells
Catheters
Transplantation
Urine

Keywords

  • Acute rejection
  • Bacteremia
  • Kidney transplantation
  • Urinary tract infection

ASJC Scopus subject areas

  • Transplantation

Cite this

Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection : A single-center report of 1166 kidney allograft recipients. / Lee, John R.; Bang, Heejung; Dadhania, Darshana; Hartono, Choli; Aull, Meredith J.; Satlin, Michael; August, Phyllis; Suthanthiran, Manikkam; Muthukumar, Thangamani.

In: Transplantation, Vol. 96, No. 8, 27.10.2013, p. 732-738.

Research output: Contribution to journalArticle

Lee, John R. ; Bang, Heejung ; Dadhania, Darshana ; Hartono, Choli ; Aull, Meredith J. ; Satlin, Michael ; August, Phyllis ; Suthanthiran, Manikkam ; Muthukumar, Thangamani. / Independent risk factors for urinary tract infection and for subsequent bacteremia or acute cellular rejection : A single-center report of 1166 kidney allograft recipients. In: Transplantation. 2013 ; Vol. 96, No. 8. pp. 732-738.
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abstract = "Background: Urinary tract infection (UTI) is a frequent, serious complication in kidney allograft recipients. Methods: We reviewed the records of 1166 kidney allograft recipients who received their allografts at our institution between January 2005 and December 2010 and determined the incidence of UTI during the first 3 months after transplantation (early UTI). We used Cox proportional hazards models to determine the risk factors for early UTI and whether early UTI was an independent risk factor for subsequent bacteremia or acute cellular rejection (ACR). Results: UTI, defined as 105 or more bacterial colony-forming units/mL urine, developed in 247 (21{\%}) of the 1166 recipients. Independent risk factors for the first episode of UTI were female gender (hazard ratio [HR], 2.9; 95{\%} confidence intervals [CI], 2.2-3.7; P<0.001), prolonged use of Foley catheter (HR, 3.9; 95{\%} CI, 2.8-5.4; P <0.001), ureteral stent (HR, 1.4; 95{\%} CI, 1.1-1.8; P=0.01), age (HR, 1.1; 95{\%} CI, 1.0-1.2; P=0.03), and delayed graft function (HR, 1.4; 95{\%} CI, 1.0-1.9; P=0.06). Trimethoprim/sulfamethoxazole prophylaxis was associated with a reduced risk of UTI (HR, 0.6; 95{\%} CI, 0.3-0.9; P=0.02). UTI was an independent risk factor for subsequent bacteremia (HR, 2.4; 95{\%} CI, 1.2-4.8; P=0.01). Untreated UTI, but not treated UTI, was associated with an increased risk of ACR (HR, 2.8; 95{\%} CI, 1.3-6.2; P=0.01). Conclusions: Female gender, prolonged use of Foley catheter, ureteral stent, age, and delayed graft function are independent risk factors for early UTI. UTI is independently associated with the development of bacteremia, and untreated UTI is associated with subsequent ACR.",
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AU - Bang, Heejung

AU - Dadhania, Darshana

AU - Hartono, Choli

AU - Aull, Meredith J.

AU - Satlin, Michael

AU - August, Phyllis

AU - Suthanthiran, Manikkam

AU - Muthukumar, Thangamani

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N2 - Background: Urinary tract infection (UTI) is a frequent, serious complication in kidney allograft recipients. Methods: We reviewed the records of 1166 kidney allograft recipients who received their allografts at our institution between January 2005 and December 2010 and determined the incidence of UTI during the first 3 months after transplantation (early UTI). We used Cox proportional hazards models to determine the risk factors for early UTI and whether early UTI was an independent risk factor for subsequent bacteremia or acute cellular rejection (ACR). Results: UTI, defined as 105 or more bacterial colony-forming units/mL urine, developed in 247 (21%) of the 1166 recipients. Independent risk factors for the first episode of UTI were female gender (hazard ratio [HR], 2.9; 95% confidence intervals [CI], 2.2-3.7; P<0.001), prolonged use of Foley catheter (HR, 3.9; 95% CI, 2.8-5.4; P <0.001), ureteral stent (HR, 1.4; 95% CI, 1.1-1.8; P=0.01), age (HR, 1.1; 95% CI, 1.0-1.2; P=0.03), and delayed graft function (HR, 1.4; 95% CI, 1.0-1.9; P=0.06). Trimethoprim/sulfamethoxazole prophylaxis was associated with a reduced risk of UTI (HR, 0.6; 95% CI, 0.3-0.9; P=0.02). UTI was an independent risk factor for subsequent bacteremia (HR, 2.4; 95% CI, 1.2-4.8; P=0.01). Untreated UTI, but not treated UTI, was associated with an increased risk of ACR (HR, 2.8; 95% CI, 1.3-6.2; P=0.01). Conclusions: Female gender, prolonged use of Foley catheter, ureteral stent, age, and delayed graft function are independent risk factors for early UTI. UTI is independently associated with the development of bacteremia, and untreated UTI is associated with subsequent ACR.

AB - Background: Urinary tract infection (UTI) is a frequent, serious complication in kidney allograft recipients. Methods: We reviewed the records of 1166 kidney allograft recipients who received their allografts at our institution between January 2005 and December 2010 and determined the incidence of UTI during the first 3 months after transplantation (early UTI). We used Cox proportional hazards models to determine the risk factors for early UTI and whether early UTI was an independent risk factor for subsequent bacteremia or acute cellular rejection (ACR). Results: UTI, defined as 105 or more bacterial colony-forming units/mL urine, developed in 247 (21%) of the 1166 recipients. Independent risk factors for the first episode of UTI were female gender (hazard ratio [HR], 2.9; 95% confidence intervals [CI], 2.2-3.7; P<0.001), prolonged use of Foley catheter (HR, 3.9; 95% CI, 2.8-5.4; P <0.001), ureteral stent (HR, 1.4; 95% CI, 1.1-1.8; P=0.01), age (HR, 1.1; 95% CI, 1.0-1.2; P=0.03), and delayed graft function (HR, 1.4; 95% CI, 1.0-1.9; P=0.06). Trimethoprim/sulfamethoxazole prophylaxis was associated with a reduced risk of UTI (HR, 0.6; 95% CI, 0.3-0.9; P=0.02). UTI was an independent risk factor for subsequent bacteremia (HR, 2.4; 95% CI, 1.2-4.8; P=0.01). Untreated UTI, but not treated UTI, was associated with an increased risk of ACR (HR, 2.8; 95% CI, 1.3-6.2; P=0.01). Conclusions: Female gender, prolonged use of Foley catheter, ureteral stent, age, and delayed graft function are independent risk factors for early UTI. UTI is independently associated with the development of bacteremia, and untreated UTI is associated with subsequent ACR.

KW - Acute rejection

KW - Bacteremia

KW - Kidney transplantation

KW - Urinary tract infection

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