Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival

Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico,...

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Autores:: Pájaro Huertas, Hernán Javier
Pantoja Echeverri, María Viviana
Martínez, Gustavo Aroca
Guido Musso, Carlos
Dominguez Vargaz, Alex
González Torres, Henry J.

Tipo de recurso:

Fecha de publicación:: 2025

Institución:: Universidad Simón Bolívar

Repositorio:: Repositorio Digital USB

Idioma:: eng

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dc.title.eng.fl_str_mv	Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival
title	Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival
spellingShingle	Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival Trasplante de riñón Infección del tracto urinario Resistencia a múltiples fármacos Función renal Supervivencia del injerto kidney transplantation Urinary tract infection Multidrug resistance Renal function Graft survival
title_short	Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival
title_full	Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival
title_fullStr	Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival
title_full_unstemmed	Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival
title_sort	Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival
dc.creator.fl_str_mv	Pájaro Huertas, Hernán Javier Pantoja Echeverri, María Viviana Martínez, Gustavo Aroca Guido Musso, Carlos Dominguez Vargaz, Alex González Torres, Henry J.
dc.contributor.author.none.fl_str_mv	Pájaro Huertas, Hernán Javier Pantoja Echeverri, María Viviana Martínez, Gustavo Aroca Guido Musso, Carlos Dominguez Vargaz, Alex González Torres, Henry J.
dc.subject.spa.fl_str_mv	Trasplante de riñón Infección del tracto urinario Resistencia a múltiples fármacos Función renal Supervivencia del injerto
topic	Trasplante de riñón Infección del tracto urinario Resistencia a múltiples fármacos Función renal Supervivencia del injerto kidney transplantation Urinary tract infection Multidrug resistance Renal function Graft survival
dc.subject.keywords.eng.fl_str_mv	kidney transplantation Urinary tract infection Multidrug resistance Renal function Graft survival
description	Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods: We conducted a retrospective, observational, analytical study including 163 kidney transplant recipients between 2015 and 2020. Clinical and microbiological variables were compared according to UTI status. Renal function was assessed using estimated glomerular filtration rate (eGFR). Graft survival was analyzed with Kaplan–Meier curves, and predictors of graft loss were identified using Cox regression models. Results: UTI prevalence was 17.8% (29/163), with a higher proportion of women in the UTI (+) group compared to the UTI (−) group (62% vs. 34%, p = 0.004). Escherichia coli (59%) and Klebsiella spp. (31%) were the predominant pathogens, with MDR in 66% of isolates and carbapenem resistance in 28%. Patients with UTIs had significantly lower baseline and follow-up eGFR (p ≤ 0.002), yet five-year graft survival was comparable (93% vs. 91%, p = 0.54). Baseline eGFR (HR: 0.95, p < 0.001) and institutional referral (HR: 9.7, p = 0.010) were independent predictors of graft loss, whereas UTIs were not associated with increased risk. Conclusions: Post-transplant UTIs in Atlántico were characterized by high antimicrobial resistance and reduced renal function, but did not affect graft survival. Antimicrobial stewardship and institutional optimization strategies are essential to improve outcomes in this vulnerable population.
publishDate	2025
dc.date.issued.none.fl_str_mv	2025
dc.date.accessioned.none.fl_str_mv	2026-01-30T21:31:33Z
dc.date.available.none.fl_str_mv	2026-01-30T21:31:33Z
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dc.type.spa.none.fl_str_mv	Artículo científico
dc.identifier.citation.none.fl_str_mv	Pájaro Huertas, H.J.; Pantoja Echeverri, M.V.; Aroca Martínez, G.; Musso, C.G.; Dominguez Vargaz, A.; González-Torres, H.J. Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival. Clin. Pract. 2025, 15, 215. https://doi.org/10.3390/clinpract15110215
dc.identifier.issn.none.fl_str_mv	2039-7283 (Electrónico)
dc.identifier.uri.none.fl_str_mv	https://hdl.handle.net/20.500.12442/17317
dc.identifier.doi.none.fl_str_mv	https://doi.org/10.3390/clinpract15110215
dc.identifier.url.none.fl_str_mv	https://www.mdpi.com/2039-7283/15/11/215
identifier_str_mv	Pájaro Huertas, H.J.; Pantoja Echeverri, M.V.; Aroca Martínez, G.; Musso, C.G.; Dominguez Vargaz, A.; González-Torres, H.J. Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival. Clin. Pract. 2025, 15, 215. https://doi.org/10.3390/clinpract15110215 2039-7283 (Electrónico)
url	https://hdl.handle.net/20.500.12442/17317 https://doi.org/10.3390/clinpract15110215 https://www.mdpi.com/2039-7283/15/11/215
dc.language.iso.none.fl_str_mv	eng
language	eng
dc.rights.eng.fl_str_mv	Attribution-NonCommercial-NoDerivatives 4.0 International
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dc.rights.accessrights.none.fl_str_mv	info:eu-repo/semantics/openAccess
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eu_rights_str_mv	openAccess
dc.format.mimetype.none.fl_str_mv	pdf
dc.publisher.spa.fl_str_mv	MDPI Ediciones Universidad Simón Bolívar Facultad de Ciencias de la Salud
dc.source.eng.fl_str_mv	Clinics and practice Clin. Pract.
dc.source.spa.fl_str_mv	Vol. 15 No. 11 Año 2025
institution	Universidad Simón Bolívar
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spelling	Pájaro Huertas, Hernán Javier2c803f9f-2d38-4a92-9896-2c576e49300d-1Pantoja Echeverri, María Viviana64f58def-2637-4605-ae07-d734725174f5-1Martínez, Gustavo Arocac2fb16e2-365e-4549-9fce-c80634aece4f-1Guido Musso, Carlos2da5aa7b-a727-493e-9477-14d1689a03f7-1Dominguez Vargaz, Alexf11668ef-f2fd-46a3-804b-f389dceab67c-1González Torres, Henry J.647be977-823a-432b-a0a3-166d8b4751c4-12026-01-30T21:31:33Z2026-01-30T21:31:33Z2025Pájaro Huertas, H.J.; Pantoja Echeverri, M.V.; Aroca Martínez, G.; Musso, C.G.; Dominguez Vargaz, A.; González-Torres, H.J. Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival. Clin. Pract. 2025, 15, 215. https://doi.org/10.3390/clinpract151102152039-7283 (Electrónico)https://hdl.handle.net/20.500.12442/17317https://doi.org/10.3390/clinpract15110215https://www.mdpi.com/2039-7283/15/11/215Objective: This study aimed to evaluate the sociodemographic, clinical, paraclinical, and microbiological characteristics of kidney transplant recipients with and without urinary tract infection (UTI) and determine their impact on renal function and graft survival in a referral center in Atlántico, Colombia. Methods: We conducted a retrospective, observational, analytical study including 163 kidney transplant recipients between 2015 and 2020. Clinical and microbiological variables were compared according to UTI status. Renal function was assessed using estimated glomerular filtration rate (eGFR). Graft survival was analyzed with Kaplan–Meier curves, and predictors of graft loss were identified using Cox regression models. Results: UTI prevalence was 17.8% (29/163), with a higher proportion of women in the UTI (+) group compared to the UTI (−) group (62% vs. 34%, p = 0.004). Escherichia coli (59%) and Klebsiella spp. (31%) were the predominant pathogens, with MDR in 66% of isolates and carbapenem resistance in 28%. Patients with UTIs had significantly lower baseline and follow-up eGFR (p ≤ 0.002), yet five-year graft survival was comparable (93% vs. 91%, p = 0.54). Baseline eGFR (HR: 0.95, p < 0.001) and institutional referral (HR: 9.7, p = 0.010) were independent predictors of graft loss, whereas UTIs were not associated with increased risk. Conclusions: Post-transplant UTIs in Atlántico were characterized by high antimicrobial resistance and reduced renal function, but did not affect graft survival. Antimicrobial stewardship and institutional optimization strategies are essential to improve outcomes in this vulnerable population.pdfengMDPIEdiciones Universidad Simón BolívarFacultad de Ciencias de la SaludAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Clinics and practiceClin. Pract.Vol. 15 No. 11 Año 2025Trasplante de riñónInfección del tracto urinarioResistencia a múltiples fármacosFunción renalSupervivencia del injertokidney transplantationUrinary tract infectionMultidrug resistanceRenal functionGraft survivalUrinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survivalinfo:eu-repo/semantics/articleArtículo científicohttp://purl.org/coar/version/c_970fb48d4fbd8a85http://purl.org/coar/resource_type/c_2df8fbb1Hariharan, S.; Israni, A.K.; Danovitch, G. Long-Term Survival after Kidney Transplantation. N. Engl. J. Med. 2021, 385, 729–743. [CrossRef] [PubMed]Fishman, J.A. Infection in Organ Transplantation. Am. J. Transplant. 2017, 17, 856–879. [CrossRef] [PubMed]Vidal, E.; Torre-Cisneros, J.; Blanes, M.; Montejo, M.; Cervera, C.; Aguado, J.M.; Len, O.; Carratalá, J.; Cordero, E.; Bou, G.; et al. Bacterial urinary tract infection after solid organ transplantation in the RESITRA cohort. Transpl. Infect. Dis. 2012, 14, 595–603. [CrossRef] [PubMed]Lee, J.R.; Bang, H.; Dadhania, D.; Hartono, C.; Aull, M.J.; Satlin, M.; August, P.; Suthanthiran, M.; Muthukumar, T. Independent Risk Factors for Urinary Tract Infection and for Subsequent Bacteremia or Acute Cellular Rejection. Transplantation 2013, 96, 732–738. [CrossRef]Camargo, L.F.; Esteves, A.B.A.; Ulisses, L.R.S.; Rivelli, G.G.; Mazzali, M. Urinary Tract Infection in Renal Transplant Recipients: Incidence, Risk Factors, and Impact on Graft Function. Transplant. Proc. 2014, 46, 1757–1759. [CrossRef]Bodro, M.; Sabé, N.; Tubau, F.; Lladó, L.; Baliellas, C.; Roca, J.; Cruzado, J.M.; Carratalà, J. Risk Factors and Outcomes of Bacteremia Caused by Drug-Resistant ESKAPE Pathogens in Solid-Organ Transplant Recipients. Transplantation 2013, 96, 843–849. [CrossRef]van Delden, C.; Blumberg, E.A. Multidrug Resistant Gram-Negative Bacteria in Solid Organ Transplant Recipients. Am. J. Transplant. 2009, 9, S27–S34. [CrossRef]van Delden, C.; Stampf, S.; Hirsch, H.H.; Manuel, O.; Meylan, P.; Cusini, A.; Hirzel, C.; Khanna, N.; Weisser, M.; Garzoni, C.; et al. Burden and Timeline of Infectious Diseases in the First Year After Solid Organ Transplantation in the Swiss Transplant Cohort Study. Clin. Infect. Dis. 2020, 71, e159–e169. [CrossRef]Hamid, R.; Javaid, S.; Khan, M.; Lal, N.; Luxmi, S.; Sarfaraz, S. Multiple Drug Resistant Urinary Tract Infection in Kidney Transplant Recipients: A Retrospective Cohort Study. Saudi J. Kidney Dis. Transplant. 2020, 31, 905. [CrossRef]Eichenberger, E.M.; Thaden, J.T. Epidemiology and Mechanisms of Resistance of Extensively Drug Resistant Gram-Negative Bacteria. Antibiotics 2019, 8, 37. [CrossRef] [PubMed]Origüen, J.; López-Medrano, F.; Fernández-Ruiz, M.; Polanco, N.; Gutiérrez, E.; González, E.; Mérida, E.; Ruiz-Merlo, T.; MoralesCartagena, A.; Pérez-Jacoiste Asín, M.A.; et al. Should Asymptomatic Bacteriuria Be Systematically Treated in Kidney Transplant Recipients? Results From a Randomized Controlled Trial. Am. J. Transplant. 2016, 16, 2943–2953. [CrossRef]Goldman, J.D.; 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. [CrossRef]Aguado, J.M.; Silva, J.T.; Fernández-Ruiz, M.; Cordero, E.; Fortún, J.; Gudiol, C.; Martínez-Martínez, L.; Vidal, E.; Almenar, L.; Almirante, B.; et al. Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations. Transplant. Rev. 2018, 32, 36–57. [CrossRef]World Health Organization. Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2022; World Health Organization: Geneva, Switzerland, 2022.Nicolle, L.E.; Bradley, S.; Colgan, R.; Rice, J.C.; Schaeffer, A.; Hooton, T.M. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clin. Infect. Dis. 2005, 40, 643–654. [CrossRef]Parasuraman, R.; Julian, K. Urinary Tract Infections in Solid Organ Transplantation. Am. J. Transplant. 2013, 13, 327–336. [CrossRef] [PubMed]Abu Jawdeh, B.G.; Me, H.M. Immunosuppression in Kidney Transplant Recipients: An Update for the General Nephrologist. Adv. Kidney Dis. Health 2024, 31, 408–415. [CrossRef] [PubMed]Schuetz, A.N.; Ferrell, A.; Hindler, J.A.; Humphries, R.; Bobenchik, A.M. Overview of changes in the Clinical and Laboratory Standards Institute Performance Standards for Antimicrobial Susceptibility Testing: M100 32nd and 33rd editions. J. Clin. Microbiol. 2025, 63, e0162323. [CrossRef] [PubMed]Magiorakos, A.-P.; Srinivasan, A.; Carey, R.B.; Carmeli, Y.; Falagas, M.E.; Giske, C.G.; Harbarth, S.; Hindler, J.F.; Kahlmeter, G.; Olsson-Liljequist, B.; et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect. 2012, 18, 268–281. [CrossRef]Posit Team. RStudio: Integrated Development Environment for R. Posit Software. PBC: Boston, MA, USA. Available online: http://www.posit.co/ (accessed on 1 July 2025).Pinchera, B.; Trucillo, E.; D’Agostino, A.; Gentile, I. Urinary Tract Infections in Kidney Transplant Patients: An Open ChallengeUpdate on Epidemiology, Risk Factors and Management. Microorganisms 2024, 12, 2217. [CrossRef]Abbott, K.C.; Oliver, J.D., III; Hypolite, I.; Lepler, L.L.; Kirk, A.D.; Ko, C.W.; Hawkes, C.A.; Jones, C.A.; Agodoa, L.Y. Hospitalizations for Bacterial Septicemia after Renal Transplantation in the United States. Am. J. Nephrol. 2001, 21, 120–127. [CrossRef]Shafiekhani, M.; Shekari, Z.; Zamani, A.; Zare, Z.; Haem, E.; Jalali, S.S.; Akbari, A.; Nikoupour, H.; Shahabinezhad, F. Antimicrobial resistance surveillance of gram-negative bacteria among solid organ transplant recipients, a 4-year retrospective study. Sci. Rep. 2025, 15, 19371. [CrossRef]Boutzoukas, A.E.; Dai, W.; Cober, E.; Abbo, L.M.; Komarow, L.; Chen, L.; Hill, C.; Satlin, M.J.; Grant, M.; Fries, B.C.; et al. Carbapenem-resistant Enterobacterales in solid organ transplant recipients. Am. J. Transplant. 2025, 25, 848–859. [CrossRef] [PubMed]Ariza-Heredia, E.J.; Beam, E.N.; Lesnick, T.G.; Kremers, W.K.; Cosio, F.G.; Razonable, R.R. Urinary tract infections in kidney transplant recipients: Role of gender, urologic abnormalities, and antimicrobial prophylaxis. Ann. Transplant. 2013, 18, 195–204. [CrossRef]Abbott, K.C.; Swanson, S.J.; Richter, E.R.; Bohen, E.M.; Agodoa, L.Y.; Peters, T.G.; Barbour, G.; Lipnick, R.; Cruess, D.F. Late urinary tract infection after renal transplantation in the United States. Am. J. Kidney Dis. 2004, 44, 353–362. [CrossRef]Strohaeker, J.; Aschke, V.; Koenigsrainer, A.; Nadalin, S.; Bachmann, R. Urinary Tract Infections in Kidney Transplant Recipients-Is There a Need for Antibiotic Stewardship? J. Clin. Med. 2021, 11, 226. [CrossRef]Huml, A.M.; Sedor, J.R.; Poggio, E.; Patzer, R.E.; Schold, J.D. An opt-out model for kidney transplant referral: The time has come. Am. J. Transplant. 2021, 21, 32–36. [CrossRef] [PubMed]Woolley, B.E.; Hong, Y.; Nasim, U.; Iyanna, N.; Dorken-Gallastegi, A.; Machinski, S.N.; Hickey, G.W.; Keebler, M.E.; Horn, E.T.; Kaczorowski, D.J. Center experience is associated with greater survival following donation after circulatory death heart transplantation. J. Hear. Lung Transplant. 2025; online ahead of print. [CrossRef] [PubMed]Bastidas-Caldes, C.; Romero-Alvarez, D.; Valdez-Vélez, V.; Morales, R.D.; Montalvo-Hernández, A.; Gomes-Dias, C.; Calvopiña, M. Extended-Spectrum Beta-Lactamases Producing Escherichia coli in South America: A Systematic Review with a One Health Perspective. Infect. Drug Resist. 2022, 15, 5759–5779. [CrossRef]Guzmán-Blanco, M.; Labarca, J.A.; Villegas, M.V.; Gotuzzo, E. Extended spectrum β-lactamase producers among nosocomial Enterobacteriaceae in Latin America. Braz. J. Infect. Dis. 2014, 18, 421–433. [CrossRef]Satlin, M.J.; Jenkins, S.G.; Walsh, T.J. The Global Challenge of Carbapenem-Resistant Enterobacteriaceae in Transplant Recipients and Patients With Hematologic Malignancies. Clin. Infect. Dis. 2014, 58, 1274–1283. [CrossRef]Sede BarranquillaEspecialización en Medicina InternaORIGINALPDF.pdfPDF.pdfapplication/pdf1272611https://bonga.unisimon.edu.co/bitstreams/61fa0788-012b-430d-a207-a6b513f207c8/download0294f4dfce79810e279aa9916bac0bc9MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8899https://bonga.unisimon.edu.co/bitstreams/2a28edc3-f0d5-4993-b94e-84db6a215734/download3b6ce8e9e36c89875e8cf39962fe8920MD52LICENSElicense.txtlicense.txttext/plain; charset=utf-83000https://bonga.unisimon.edu.co/bitstreams/e0744a67-e0dd-4012-b3a4-373a1e8611b4/download2a1661e5960a7bab4fd8dda692fb677cMD5320.500.12442/17317oai:bonga.unisimon.edu.co:20.500.12442/173172026-01-30 16:37:01.485http://creativecommons.org/licenses/by-nc-nd/4.0/Attribution-NonCommercial-NoDerivatives 4.0 Internationalopen.accesshttps://bonga.unisimon.edu.coRepositorio Digital Universidad Simón Bolívarrepositorio.digital@unisimon.edu.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

Urinary Tract Infections and Bacterial Multidrug Resistance in Kidney Transplant Impact on Function and Graft Survival

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