Introduction: Urinary tract infections (UTI) are identified more frequently amongst children after kidney transplants than the general population. These infections can have significant consequences acutely and increase the risk of rejection and long -term graft failure. Further understanding regarding risk factors and antibiotic sensitivity results can guide appropriately targeted investigation and management. The aim of this study was to assess the frequency of UTI and features that predict increased risk of UTI in paediatric kidney transplant recipients.
Method: A single-centre retrospective cohort study of paediatric kidney transplant recipients. Data collected included patient demographics, pre-transplant history of UTI and urology involvement, pre-transplant imaging and post-transplant UTI, including clinical features, urine culture results, organism resistance patterns and clinical treatment.
Results:  A total of 52 patients were included in the study. Mean age at transplant was 7 years (s.d. 4.1). Twenty one children (40%) developed at least one UTI over a mean follow up of 7 years (s.d. 3.1) with a total of 67 urinary tract infections recorded in the cohort. Thirteen episodes (20%) of UTI resulted in hospitalization for treatment.  Escherichia coli accounted for 34 episodes of UTI (54%), with Enterococcus faecalis (n=9, 14%) and Klebsiella pneumoniae (n=6, 9%) the next most common. Seventeen episodes (25%) of UTI occurred when patients were receiving antibiotic prophylaxis. The majority of UTI were treated with cephalosporin (n=27, 40%) and beta-lactam (n=25, 37%) antibiotics. In 43 episodes of UTI (64%) the organisms grown were sensitive to the empirically chosen antibiotic. A history of pre-transplant UTI was associated with increased risk of UTI (57% vs 43%; p value <0.01), as was a history of pre-transplant urology involvement (7 of 10 children, 33% of UTI; p value 0.03), and specifically vesicostomy (5 of 6 children, 24% of UTI; p value 0.02).
Conclusion: UTI is common in individuals after paediatric renal transplant. Pre-transplant history of UTI and urology involvement is associated with increased risk of UTI. Ongoing monitoring of evolving antibiotic resistance patterns is necessary to improve appropriateness of empirical therapy and limit the development of multi-resistant drug organisms.