The challenge of urinary tract infections in renal transplant recipients

Ian Hollyer, Michael G Ison*

*Corresponding author for this work

Research output: Contribution to journalReview article

9 Citations (Scopus)

Abstract

Urinary tract infections (UTI) are an important cause of morbidity and mortality in renal transplant patients. These infections are quite common, and the goal of care is to identify and reduce risk factors while providing effective prophylaxis and treatment. Better understanding of long-term outcomes from these infections has led to the distinctions among UTI, recurrent UTI, and asymptomatic bacteriuria (ASB), and that each requires a different therapeutic approach. Specifically, new research has supported the perspective that asymptomatic bacteriuria should not be treated. Symptomatic UTI, on the other hand, requires intervention and remains an ongoing challenge for infectious disease clinicians. Many bacteria species are responsible for UTI in renal transplant patients, and in recent years there has been a global rise in infection caused by bacteria with newly acquired antibacterial resistance genes. Many renal transplant patients who experience UTI will also have multiple recurring episodes, which likely has a distinct pathophysiological mechanism leading to chronic colonization of the urinary tract. In these cases, long-term management includes bacterial suppression, which aims to reduce rather than eliminate bacteria to levels below the threshold for symptomatic infection. This review will address the current understanding of UTI epidemiology, pathogenesis, and risk factors in the renal transplant community, and also focus on current prevention and treatment strategies for patients who face an environment of increasingly antibiotic-resistant bacteria.

Original languageEnglish (US)
Article numbere12828
JournalTransplant Infectious Disease
Volume20
Issue number2
DOIs
StatePublished - Apr 1 2018

Fingerprint

Urinary Tract Infections
Kidney
Bacteria
Transplants
Bacteriuria
Infection
Patient Care Planning
Transplant Recipients
Urinary Tract
Communicable Diseases
Epidemiology
Therapeutics
Anti-Bacterial Agents
Morbidity
Mortality
Research
Genes

Keywords

  • bactiuria
  • methenamine
  • urinary tract infection

ASJC Scopus subject areas

  • Infectious Diseases
  • Transplantation

Cite this

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title = "The challenge of urinary tract infections in renal transplant recipients",
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The challenge of urinary tract infections in renal transplant recipients. / Hollyer, Ian; Ison, Michael G.

In: Transplant Infectious Disease, Vol. 20, No. 2, e12828, 01.04.2018.

Research output: Contribution to journalReview article

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AU - Hollyer, Ian

AU - Ison, Michael G

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AB - Urinary tract infections (UTI) are an important cause of morbidity and mortality in renal transplant patients. These infections are quite common, and the goal of care is to identify and reduce risk factors while providing effective prophylaxis and treatment. Better understanding of long-term outcomes from these infections has led to the distinctions among UTI, recurrent UTI, and asymptomatic bacteriuria (ASB), and that each requires a different therapeutic approach. Specifically, new research has supported the perspective that asymptomatic bacteriuria should not be treated. Symptomatic UTI, on the other hand, requires intervention and remains an ongoing challenge for infectious disease clinicians. Many bacteria species are responsible for UTI in renal transplant patients, and in recent years there has been a global rise in infection caused by bacteria with newly acquired antibacterial resistance genes. Many renal transplant patients who experience UTI will also have multiple recurring episodes, which likely has a distinct pathophysiological mechanism leading to chronic colonization of the urinary tract. In these cases, long-term management includes bacterial suppression, which aims to reduce rather than eliminate bacteria to levels below the threshold for symptomatic infection. This review will address the current understanding of UTI epidemiology, pathogenesis, and risk factors in the renal transplant community, and also focus on current prevention and treatment strategies for patients who face an environment of increasingly antibiotic-resistant bacteria.

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