Urinary tract infection (UTI) is the most common infection after renal transplantation and is a major cause of morbidity and mortality among transplant recipients [1-3]. UTI is associated with the development of impaired allograft function, allograft loss, and death [3,4].
This topic reviews the epidemiology, risk factors, microbiology, clinical presentation, diagnosis, management, and prevention of bacterial and fungal UTI among renal transplant recipients. UTI in the general population and among end-stage renal disease (ESRD) patients is discussed elsewhere. (See "Acute uncomplicated cystitis and pyelonephritis in women" and "Approach to the adult with asymptomatic bacteriuria" and "Recurrent urinary tract infection in women" and "Non-access related infections in chronic dialysis patients", section on 'Genitourinary infection'.)
Urinary tract infection (UTI) comprises approximately 45 to 47 percent of infectious complications of renal transplantation [1,2]. The incidence of UTI following transplantation has decreased because of improvements in surgical procedures, rapid removal of the urethral catheter, refinements in immunosuppressive therapy, and routine administration of antibiotic prophylaxis [5,6]. The reported incidence varies widely, likely due to differences in definition, diagnostic criteria, study design, and length of observation . As examples:
- In one study of 161 patients transplanted at a single center between 2003 and 2005, 41 patients (25 percent) developed at least one UTI .
- In another study that included 177 patients transplanted between 2000 and 2005, 75 percent of patients developed at least one UTI .
The pathogenesis of urinary tract infection (UTI) in the transplant recipient is similar to that in the general population. (See "Acute uncomplicated cystitis, pyelonephritis, and asymptomatic bacteriuria in men", section on 'Pathogenesis' and "Acute uncomplicated cystitis and pyelonephritis in women", section on 'Pathogenesis' and "Emphysematous urinary tract infections", section on 'Pathogenesis'.)