Recurrent and Multi-Drug-Resistant UTI Treatments in Kidney Transplant Patients: A Retrospective Study from Saudi Arabia

Background: Urinary tract infections (UTIs) are the most common infections among kidney transplant recipients, with prevalence rates ranging from 12% to 75% in studies from North America and Australia, and 4.5% to 85% in the Middle East. These infections can significantly impact graft survival and patient quality of life, increasing the risk of hospitalization, morbidity, and mor-tality. Escherichia coli is the leading cause of UTIs in transplant patients, followed by Klebsiella pneumoniae, Enterococcus species, Pseudomonas aeruginosa, and Proteus. Several factors, including advanced age, female gender, and use of urinary catheters, contribute to post-transplant UTIs. This study focuses on the Saudi population, aiming to assess the prevalence, risk factors, and treatment strategies for recurrent and multi-drug-resistant UTIs in kidney transplant recipients. Methods: This cross-sectional study reviewed the medical records of kidney transplant patients at King Faisal Specialist Hospital & Research Center, Jeddah, in addition to data from King Fahad Hospital, Madinah, Saudi Arabia between March and May 2022. Adult patients who developed recurrent UTIs within two years post-transplant were included, while those with one or no UTI episode or incomplete records were excluded. Results: Among the study population, Klebsiella pneumoniae was the most frequently identified pathogen (42.9%). The majority of cases involved complicated infections. Carbapenems were primarily used for complicated UTIs, while cephalosporins and penicillin were used for uncomplicated infections. Despite the high recurrence of UTIs, antimicrobial prevention was rarely applied. Conclusion: Recurrent UTIs are common in kidney transplant recipients, particularly in patients over 45, with multi-drug-resistant organ-sms, or with ureteric stents. Though these infections do not directly threaten the graft, they can lead to increased creatinine levels, hospitalizations, and healthcare costs. Further research on prevention strategies is needed to reduce the burden on both patients and healthcare systems. Keywords: Urinary tract infection, kidney transplant, Saudi Arabia, Infection, Multi-Drug-Resistant