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Article

Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis

by
Chayanan Santithanmakorn
1,
Jakapat Vanichanan
2,
Natavudh Townamchai
3,4,5,
Kamonwan Jutivorakool
2,
Salin Wattanatorn
3,
Methee Sutherasan
4,6,
Julin Opanuruk
6,
Stephen J. Kerr
7,8,9,
Kearkiat Praditpornsilpa
3,
Yingyos Avihingsanon
3,4,5 and
Suwasin Udomkarnjananun
3,4,5,*
1
Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
2
Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
3
Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
4
Excellence Center for Organ Transplantation (ECOT), King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand
5
Renal Immunology and Transplantation Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
6
Department of Surgery, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok 10330, Thailand
7
Biostatistics Excellence Centre, Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
8
HIV-NAT, Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand
9
The Kirby Institute, University of New South Wales, Sydney 2052, Australia
*
Author to whom correspondence should be addressed.
Biomedicines 2022, 10(11), 2984; https://doi.org/10.3390/biomedicines10112984
Submission received: 14 October 2022 / Revised: 4 November 2022 / Accepted: 15 November 2022 / Published: 20 November 2022
(This article belongs to the Special Issue Emerging Issues in Immune Mechanism of Kidney Diseases)
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Abstract

Risk factors and consequences of urinary tract infection (UTI) post-kidney transplant have been variously reported by studies that were heterogenous in immunosuppressants and prophylactic protocols. We aimed to clarify the risks and consequences of UTI in kidney transplant recipients with post-transplantation cotrimoxazole prophylaxis in the context of modern immunosuppression. This retrospective cohort included kidney transplant recipients receiving tacrolimus, mycophenolate, prednisolone, and cotrimoxazole for bacterial UTI prophylaxis. Recipients were categorized into non-UTI and UTI groups. Asymptomatic bacteriuria (ASB) was screened in the first 3 months and was evaluated for association with UTI. Of 348 kidney transplant recipients, 129 were in the UTI group and 219 in the non-UTI group. UTI risk factors were female sex, body mass index ≥ 25 kg/m2, human leukocyte antigen mismatch, and panel reactive antibody ≥ 50%. Recipients with recurrent UTI had inferior allograft function compared with non-UTI recipients. Patient survival was significantly lower in recipients with UTI in the first post-transplant month. Higher degree of immunosuppressions was associated with recurrent UTI and drug-resistant organisms. In conclusion, UTI continues to negatively affect graft function and survival of kidney transplant recipients. Treating ASB in the first 3 months did not reduce the UTI incidence in the first transplantation year.
Keywords: asymptomatic bacteriuria; immunosuppression; kidney transplantation; overweight; tacrolimus; urinary tract infection asymptomatic bacteriuria; immunosuppression; kidney transplantation; overweight; tacrolimus; urinary tract infection

Share and Cite

MDPI and ACS Style

Santithanmakorn, C.; Vanichanan, J.; Townamchai, N.; Jutivorakool, K.; Wattanatorn, S.; Sutherasan, M.; Opanuruk, J.; Kerr, S.J.; Praditpornsilpa, K.; Avihingsanon, Y.; et al. Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis. Biomedicines 2022, 10, 2984. https://doi.org/10.3390/biomedicines10112984

AMA Style

Santithanmakorn C, Vanichanan J, Townamchai N, Jutivorakool K, Wattanatorn S, Sutherasan M, Opanuruk J, Kerr SJ, Praditpornsilpa K, Avihingsanon Y, et al. Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis. Biomedicines. 2022; 10(11):2984. https://doi.org/10.3390/biomedicines10112984

Chicago/Turabian Style

Santithanmakorn, Chayanan, Jakapat Vanichanan, Natavudh Townamchai, Kamonwan Jutivorakool, Salin Wattanatorn, Methee Sutherasan, Julin Opanuruk, Stephen J. Kerr, Kearkiat Praditpornsilpa, Yingyos Avihingsanon, and et al. 2022. "Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis" Biomedicines 10, no. 11: 2984. https://doi.org/10.3390/biomedicines10112984

APA Style

Santithanmakorn, C., Vanichanan, J., Townamchai, N., Jutivorakool, K., Wattanatorn, S., Sutherasan, M., Opanuruk, J., Kerr, S. J., Praditpornsilpa, K., Avihingsanon, Y., & Udomkarnjananun, S. (2022). Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis. Biomedicines, 10(11), 2984. https://doi.org/10.3390/biomedicines10112984

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