Post-Kidney Transplant Urinary Tract Infections: Incidence, Risk Factors, and Outcomes – A Single center Experience

Background: Urinary tract infections (UTIs) are among the most common infectious complications following kidney transplantation and may adversely affect patient and graft outcomes. Despite their clinical importance, there are limited contemporary data from India describing incidence, risk factors, and resistance patterns. Materials and Methods: We conducted a retrospective study of 272 adult kidney transplant recipients who underwent transplantation at our center between January 2020 and December 2023. Patients were followed for one year posttransplant. Demographic, clinical, and microbiological data were collected from electronic records. Outcomes of patients with and without UTI were compared. Multivariate logistic regression was used to identify independent predictors of UTI. Results: Posttransplant UTI occurred in 55 patients (20.2%). Female sex (odds ratio [OR] 3.98, 95% confidence interval [CI] 1.69–9.39, P = 0.002), pretransplant diabetes mellitus (OR 3.98, 95% CI 1.55–10.25, P = 0.004), and prolonged DJ stent duration (OR 1.36, 95% CI 1.08–1.71, P = 0.008) were independent risk factors. Escherichia coli (53%) and Klebsiella spp. (35%) were the predominant isolates, with 71% being multidrug-resistant and 15% pan-drug-resistant (PDR). Among PDR isolates, synergy testing with ceftazidime plus aztreonam showed 100% in vitro synergy, correlating with clinical improvement in all treated cases. At 1 year, graft loss attributable to UTI occurred in 3.6% and mortality due to urosepsis in 1.8%. Conclusion: Female sex, diabetes, and prolonged DJ stent duration significantly increased the risk of UTI after kidney transplantation. High resistance rates, including PDR pathogens, highlight the importance of local surveillance, timely stent removal, and advanced microbiological testing to optimize prevention and treatment strategies.