Persistent Urinary Tract Infections After Kidney Transplantation: Risk Factors and Management

Abstract

Background: Persistent urinary tract infections (UTIs) are a frequent complication among kidney transplant recipients, often leading to increased morbidity, healthcare costs, and potential compromise of graft function. Identifying risk factors and effective management strategies is crucial to improve clinical outcomes in this vulnerable patient population. Methods: In this retrospective study conducted from January 2020 to December 2024, 1130 kidney transplant recipients aged 18 to 75 years were analyzed. Clinical and laboratory data were obtained from electronic medical records, with information on demographics, immunosuppressive regimens, microbiological findings, and treatment outcomes. Persistent UTIs were defined as 2 or more microbiologically confirmed episodes within 12 months despite appropriate therapy. Statistical analyses included descriptive measures, comparative tests, and multivariate logistic regression to identify independent predictors. Results: Of the total cohort, 31.2% developed persistent UTIs, with 68.5% experiencing recurrent episodes. Diabetes mellitus (adjusted OR: 1.56), prolonged urinary catheterization (adjusted OR: 2.04), and infection with multidrug-resistant (MDR) pathogens (adjusted OR: 2.32) emerged as significant risk factors. Escherichia coli was the most frequently isolated organism (36.4%), followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Patients with persistent UTIs exhibited lower mean eGFR levels, although graft loss rates did not differ significantly from those without persistent UTIs. Conclusion: Persistent UTIs represent a major clinical challenge in kidney transplant recipients. Early identification of modifiable risk factors—particularly glycemic control and appropriate urinary catheter management—may reduce recurrence and preserve renal function. A comprehensive approach involving routine microbiological surveillance and judicious antibiotic use is essential to mitigate the impact of MDR organisms on patient outcomes. © 2026