Urinary Tract Infections Caused by K. pneumoniae in Kidney Transplant Recipients - Epidemiology, Virulence and Antibiotic Resistance

Abstract

Urinary tract infections are the most common complication in kidney transplant recipients, possibly resulting in the deterioration of a long-term kidney allograft function and an increased risk of recipient's death. K. pneumoniae has emerged as one of the most prevalent etiologic agents in the context of recurrent urinary tract infections, especially with multidrug resistant strains. This paper discusses the epidemiology and risk factors associated with urinary tract infections in kidney transplant recipients, multi-drug resistance of K. pneumoniae (ESBL, KPC, NDM), treatment and pathogenesis of K. pneumoniae infections, and possible causes of recurrent UTIs. It also addresses the issue of colonization/becoming a carrier of K. pneumoniae in the gastrointestinal tract and asymptomatic bacteriuria in relation to a symptomatic UTI development and epidemiology.

Keywords: Klebsiella pneumoniae; MDR; UTI; asymptomatic bacteriuria; colonization; kidney transplant recipient; recurrent UTI; virulence factors.

Figure 1

The incidence of K. pneumoniae UTIs in renal transplant recipients by countries in which the study was conducted. The study period (in years) is shown in the labels. This analysis was performed based on following references: Abbott et al., 2004; Charfeddine et al., 2002; Chuang et al., 2005; Alangaden et al., 2006; Dantas et al., 2006; Valera et al., 2006; Dupont et al., 2007; Memikoğlu et al., 2007; Pourmand et al., 2007; López-Medrano et al., 2008; Giullian et al., 2010; Iqbal et al., 2010; Rivera-Sanchez et al., 2010; Fiorante et al., 2011; Gołębiewska et al., 2011; Papasotiriou et al., 2011; Barbouch et al., 2012; Vidal et al., 2012; Lee et al., 2013; Lim et al., 2013; Silva et al., 2013; Wu et al., 2013; Ariza-Heredia et al., 2014; Adamska et al., 2015; Gozdowska et al., 2016; Singh et al., 2016b; Al Midani et al., 2018; Mukherjee et al., 2018; Olenski et al., 2019; Tekkarışmaz et al., 2020; Shimizu et al., 2021.

Figure 2

Risk factors related to K. pneumoniae for renal transplant recipients. BSI, blood stream infection; Vfs, virulence factors; ARG, antibiotic resistance gene/s; ESBL, Extended-spectrum β-lactamases; NDM-1, New Delhi metallo-β-lactamase 1; KPC, carbapenemases.