Background. Urinary tract infections (UTIs) are the most frequent infectious complication after kidney transplantation and are associated with rehospitalizations, impaired allograft function, and reduced graft and recipient survival. Their clinical relevance is ampli ed by chronic kidney disease (CKD)−related immune dysfunction and the rising burden of antimicrobial resistance Methods. We provide a focused narrative review of classi cation, pathophysiology, risk fac- tors, and evidence-based management and prevention strategies for UTIs in kidney transplant recipients, with emphasis on antimicrobial stewardship and non-antibiotic adjuncts Results. Post-transplant UTI risk is highest in the early months and is driven by intensive immu- nosuppression, perioperative urological devices (bladder catheter, ureteral stents), delayed graft func- tion/ischemia−reperfusion injury, and urodynamic abnormalities (post-void residual, vesicoureteral re ux). Female sex and pregnancy further increase susceptibility. Urine cultures must be interpreted in the context of time from transplantation and symptoms. Systematic treatment of asymptomatic bacteriuria is not bene cial and may increase antibiotic exposure and selection of multidrug-resistant organisms. Conversely, symptomatic, complicated, and recurrent UTIs warrant prompt empiric ther- apy followed by rapid de-escalation based on culture and susceptibility results. Preventive strategies targeting adhesion and colonization include adequate hydration, standardized cranberry preparations with therapeutically effective proanthocyanidin dosing, methenamine hippurate in selected patients, and topical vaginal estrogen in peri-/postmenopausal women; evidence for D-mannose and probiot- ics remains inconsistent. Emerging mechanistic insights highlight uromodulin as a key anti-adhesive and neutrophil (NET)-modulating defense factor, while SGLT2 inhibitors may modify tubular bio- markers; a UTI episode should not automatically prompt treatment discontinuation Conclusions. UTI management after kidney transplantation should adopt an integrated, multi- modal approach combining stewardship-driven antibiotic use with tailored non-antibiotic preven- tive interventions to reduce recurrences, curb resistance, and preserve long-term allograft longevity.
Urinary Tract Infections in Kidney Transplant Recipients: A Narrative Review
Carmine Secondulfo;Giancarlo Bilancio
2026
Abstract
Background. Urinary tract infections (UTIs) are the most frequent infectious complication after kidney transplantation and are associated with rehospitalizations, impaired allograft function, and reduced graft and recipient survival. Their clinical relevance is ampli ed by chronic kidney disease (CKD)−related immune dysfunction and the rising burden of antimicrobial resistance Methods. We provide a focused narrative review of classi cation, pathophysiology, risk fac- tors, and evidence-based management and prevention strategies for UTIs in kidney transplant recipients, with emphasis on antimicrobial stewardship and non-antibiotic adjuncts Results. Post-transplant UTI risk is highest in the early months and is driven by intensive immu- nosuppression, perioperative urological devices (bladder catheter, ureteral stents), delayed graft func- tion/ischemia−reperfusion injury, and urodynamic abnormalities (post-void residual, vesicoureteral re ux). Female sex and pregnancy further increase susceptibility. Urine cultures must be interpreted in the context of time from transplantation and symptoms. Systematic treatment of asymptomatic bacteriuria is not bene cial and may increase antibiotic exposure and selection of multidrug-resistant organisms. Conversely, symptomatic, complicated, and recurrent UTIs warrant prompt empiric ther- apy followed by rapid de-escalation based on culture and susceptibility results. Preventive strategies targeting adhesion and colonization include adequate hydration, standardized cranberry preparations with therapeutically effective proanthocyanidin dosing, methenamine hippurate in selected patients, and topical vaginal estrogen in peri-/postmenopausal women; evidence for D-mannose and probiot- ics remains inconsistent. Emerging mechanistic insights highlight uromodulin as a key anti-adhesive and neutrophil (NET)-modulating defense factor, while SGLT2 inhibitors may modify tubular bio- markers; a UTI episode should not automatically prompt treatment discontinuation Conclusions. UTI management after kidney transplantation should adopt an integrated, multi- modal approach combining stewardship-driven antibiotic use with tailored non-antibiotic preven- tive interventions to reduce recurrences, curb resistance, and preserve long-term allograft longevity.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
