Recurrent and Multidrug-Resistant UTI Treatments in Kidney Transplant Patients: A Retrospective Study from Saudi Arabia

<b>Background:</b> Urinary tract infections (UTIs) are the most common infections among kidney transplant recipients, with prevalence rates ranging from 12% to 75% in studies from North America and Australia and from 4.5% to 85% in the Middle East. These infections can significantly impact graft survival and patient quality of life, increasing the risk of hospitalization, morbidity, and mortality. <i>Escherichia coli</i> is the leading cause of UTIs in transplant patients, but multidrug-resistant (MDR) pathogens are a growing concern, especially in Saudi Arabia. Several factors, including advanced age, female gender, and use of urinary catheters, contribute to post-transplant UTIs. This study focuses on the Saudi population, aiming to assess the prevalence, risk factors, and treatment strategies for recurrent and multidrug-resistant UTIs in kidney transplant recipients. <b>Methods:</b> This retrospective cohort study reviewed the medical records of kidney transplant patients at King Faisal Specialist Hospital & Research Center, Jeddah, in addition to data from King Fahad Hospital, Madinah, Saudi Arabia, between March and May 2022. Adult patients (≥18 years) who developed recurrent UTIs within two years post-transplant were included, while those with one or no UTI episode or incomplete records were excluded. <b>Results:</b> Seventy-five of 491 screened patients (15.3%) experienced recurrent UTIs, contributing to a total of 219 episodes. <i>Klebsiella pneumoniae</i> was the most frequent pathogen, isolated in 94 episodes (42.9%). Key risk factors for recurrence included complicated UTIs (OR = 4.60, <i>p</i> = 0.005), multidrug-resistant organisms (MDROs) (OR = 3.14, <i>p</i> = 0.021), and ureteric stents (OR = 4.07, <i>p</i> = 0.042). Carbapenems were primarily used for complicated UTIs, while cephalosporins and penicillins were used for uncomplicated infections. A significant post-UTI rise in serum creatinine was observed (<i>p</i> < 0.001). <b>Conclusions:</b> Recurrent UTIs predominantly caused by <i>K. pneumoniae</i> are common in kidney transplant recipients, particularly in patients over 45, with multidrug-resistant organisms, or with ureteric stents. While a direct causal link to graft loss was not established, these infections can lead to increased creatinine levels, hospitalizations, and healthcare costs and increased carbapenem use. These findings highlight the critical need for institution-specific antimicrobial stewardship programs focused on infection prevention and optimized antibiotic use to improve outcomes in this vulnerable population.