Host and pathogen factors in Klebsiella pneumoniae upper urinary tract infections in renal transplant patients

— The Authors report on three cases of nephrogenic adenoma of the bladder in a population of 796 renal transplant patients. According to their experience the Authors think that a more aggressive approach is advisable in transplant patients with frequent urinary tract infections and/or hematuria.

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Urinary tract infections in post-renal transplant patients

International Urology and Nephrology ◽

10.1007/bf02549801 ◽

1990 ◽

Vol 22 (4) ◽

pp. 389-396 ◽

Cited By ~ 22

Author(s):

P. C. K. Chan ◽

I. K. P. Cheng ◽

K. K. Wong ◽

M. K. Li ◽

M. K. Chan

Keyword(s):

Urinary Tract ◽

Renal Transplant ◽

Urinary Tract Infections ◽

Transplant Patients ◽

Renal Transplant Patients ◽

Tract Infections

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Faecal Microbiota Transplantation Eradicated Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae from a Renal Transplant Recipient with Recurrent Urinary Tract Infections

Case Reports in Nephrology and Dialysis ◽

10.1159/000502336 ◽

2019 ◽

Vol 9 (2) ◽

pp. 102-107 ◽

Cited By ~ 7

Author(s):

Anne Karmisholt Grosen ◽

Johan Vestergaard Povlsen ◽

Lars Erik Lemming ◽

Simon Mark Dahl Jørgensen ◽

Jens Frederik Dahlerup ◽

...

Keyword(s):

Urinary Tract ◽

Renal Transplant ◽

Klebsiella Pneumoniae ◽

Urinary Tract Infections ◽

Beta Lactamase ◽

Faecal Microbiota ◽

Extended Spectrum Beta Lactamase ◽

Faecal Microbiota Transplantation ◽

Extended Spectrum ◽

Tract Infections

Renal transplant recipients (RTRs) are highly susceptible to infections, and antimicrobial resistance is an increasing problem with limited treatment options. Faecal microbiota transplantation (FMT) is effective for recurrent Clostridium difficile infection and may be used for patients with intestinal carriage of multidrug-resistant (MDR) microorganisms. We present a RTR who suffered from recurrent urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase-producing (ESBL+) Klebsiella pneumoniae. Blood and urinary isolates revealed the same antibiotic susceptibility pattern, and whole-genome sequencing confirmed identical isolates in blood and urine. Despite several treatments with meropenem, the patient experienced recurrent infections that caused hospitalisation. ESBL+ K. pneumoniae was isolated in faeces. In an attempt to decolonise the gut, FMT was performed. A few days after nasojejunal infusion of donor faeces, the patient experienced a single relapse of UTI. During the subsequent 12 months, no further episodes of UTI occurred. Absence of ESBL+ K. pneumoniae in urine and faeces was demonstrated during follow-up. We conclude that FMT may be an effective treatment in RTRs with recurrent UTIs caused by intestinal colonisation with MDR organisms.

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2662. Methenamine Hippurate Decreases the Incidence of Urinary Tract Infections in Adult Renal Transplant Recipients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2340 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S931-S932

Author(s):

Orlando Quintero ◽

Yoram Puius ◽

Vagish Hemmige

Keyword(s):

Urinary Tract ◽

Renal Transplant ◽

Creatinine Clearance ◽

Kidney Transplant ◽

Urinary Tract Infections ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Transplant Patients ◽

Number Of Patients ◽

Tract Infections

Abstract Background Urinary tract infections (UTIs) are a common complication of renal transplantation. Methenamine hippurate is a non-antibiotic alternative that reduces the frequency of UTIs in selected non-transplant patients, but which is not recommended in renal insufficiency. We conducted a retrospective study to determine the efficacy of methenamine prophylaxis in our kidney transplant population, and identify subgroups for which efficacy is greatest. Methods Retrospective chart review of adult kidney transplant patients at Montefiore Medical Center who were prescribed methenamine during January 1, 2016–December 31, 2017, with extraction of clinical data in the year before and after prophylaxis. Variables included demographics, creatinine clearance and hemoglobin A1c levels at the time of prescription, incidence of UTIs as determined by standardized literature definitions, hospital admissions for infections, and antibiotic use. Results The incidence of UTIs per 1000 patient-days decreased significantly, from 9.66 (95% CI 7.53–12.40) the year before to 3.24 (95% CI 2.00–5.24) the year after (P < 0.001). The effect was significantly more pronounced in patients who were transplanted due to diabetic nephropathy, with a decreased incidence of 13.05 (95% Cl 10.00–17.02) UTIs/1000 patient-days to 2.90 (95% Cl 1.58–5.32) in diabetics (P < 0.001), vs. 5.50 (95% Cl 3.65–8.28) UTIs/1000 patient-days to 3.81 (95% Cl 1.70–8.55) in non-diabetics (P = 0.44). The number of days of antibiotics for UTIs per 1000 days also decreased significantly for all patients, from 128.58 (95% CI 94.87–174.28) the year before to 49.78 (95% CI 31.74–78.07) the year after (P = 0.001). No significant differences in efficacy were seen based on sex or renal function. Three patients with indwelling urinary catheters or who required intermittent catheterization did not appear to benefit Conclusion Methenamine prophylaxis decreases the incidence of UTIs and number of antibiotic days in adult renal transplant recipients. This effect was seen even in patients with reduced creatinine clearance. Patients with diabetes benefited the most. The small number of patients who required catheterization did not appear to benefit. Disclosures All authors: No reported disclosures.

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Urinary Tract Infections in Kidney Transplant Patients Due to Escherichia coli and Klebsiella pneumoniae-Producing Extended-Spectrum β-Lactamases: Risk Factors and Molecular Epidemiology

PLoS ONE ◽

10.1371/journal.pone.0134737 ◽

2015 ◽

Vol 10 (8) ◽

pp. e0134737 ◽

Cited By ~ 28

Author(s):

Maria José Espinar ◽

Isabel M. Miranda ◽

Sofia Costa-de-Oliveira ◽

Rita Rocha ◽

Acácio G. Rodrigues ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Urinary Tract ◽

Klebsiella Pneumoniae ◽

Molecular Epidemiology ◽

Kidney Transplant ◽

Urinary Tract Infections ◽

Transplant Patients ◽

Kidney Transplant Patients ◽

Tract Infections

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The New Klebsiella pneumoniae ST152 Variants with Hypermucoviscous Phenotype Isolated from Renal Transplant Recipients with Asymptomatic Bacteriuria—Genetic Characteristics by WGS

Genes ◽

10.3390/genes11101189 ◽

2020 ◽

Vol 11 (10) ◽

pp. 1189

Author(s):

Magdalena Wysocka ◽

Roxana Zamudio ◽

Marco R Oggioni ◽

Justyna Gołębiewska ◽

Aleksandra Dudziak ◽

...

Keyword(s):

Urinary Tract ◽

Renal Transplant ◽

Klebsiella Pneumoniae ◽

Urinary Tract Infections ◽

Asymptomatic Bacteriuria ◽

Renal Transplant Recipients ◽

High Plasticity ◽

Nucleotide Polymorphisms ◽

Genetic Characteristics ◽

Tract Infections

Klebsiella pneumoniae (Kp) is one of the most important etiological factors of urinary tract infections in renal transplant (RTx) recipients. We described the antimicrobial susceptibility phenotypes and genomic features of two hypermucoviscous (HM) Kp isolates recovered from RTx recipients with asymptomatic bacteriuria (ABU). Using whole genome sequencing (WGS) data, we showed that the strains belong to the ST152 lineage with the KL149 capsular serotype, but without rmpA/magA genes, which is typical for HM+ hypervirulent Kp. These new strains carried virulence-associated genes that predispose for urinary tract infections (UTIs). Likewise, both strains carried the ecp gene encoding pilus common for extended-spectrum β-lactamase (ESBL) Escherichia coli. Although the two ST152 isolates were closely related and differed by only nine single nucleotide polymorphisms (SNPs) in their chromosomes, they had different plasmid compositions and chromosomal elements, with isolate KP28872 carrying an ESBL plasmid and an integrative conjugative element. These two isolates are an example of the high plasticity of the K. pneumoniae accessory genome. The identification of patients with ABU matched with the correct epidemiological profiling of isolates could facilitate interventions to prevent or rapidly treat K. pneumoniae infections.

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