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Nitrofurantoin Susceptibility and the Landscape of Multidrug-Resistant Gram-Negative Uropathogens in Kidney Transplant Recipients During the First Post-Transplant Year
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DOI：10.3390/antibiotics15080769.png)
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Abstract
En 中文
Background: Multidrug-resistant (MDR) Gram-negative urinary tract infections (UTIs) frequently complicate the first post-transplant year in kidney transplant (KTX) recipients. This study characterized patterns of uropathogen susceptibility, MDR prevalence, and predictors of MDR UTI in this population. Methods: In a single-center retrospective cross-sectional study (KFSHRC, Riyadh; October 2024 to December 2025), 83 adult first-transplant recipients with a first-year Gram-negative UTI were included for analysis. Susceptibility was determined using VITEK 2/CLSI criteria, and MDR was defined according to Magiorakos/ECDC criteria. Results: Nitrofurantoin susceptibility varied significantly by species, with 89.2% in E. coli compared to 15.0% in K. pneumoniae (p < 0.001), supporting its use as a carbapenem-sparing option for E. coli but not for K. pneumoniae. Carbapenems and amikacin retained near-complete activity, whereas cephalosporins, ciprofloxacin, and trimethoprim-sulfamethoxazole exhibited resistance rates of 45 to 68%. K. pneumoniae (49.4%) and E. coli (44.6%) were the predominant uropathogens, and MDR accounted for 63.9% of episodes (95% CI 53.1 to 73.4). MDR was associated with UTI recurrence, prolonged hospitalization, and reduced microbiological eradication (69.8% vs. 86.7%). UTI recurrence was the only independent predictor of MDR status (adjusted OR, 3.99; 95% CI, 1.46 to 10.89; p = 0.007). No UTI-associated mortality occurred within one year. Conclusions: Species-directed therapy, such as nitrofurantoin for E. coli and carbapenems or aminoglycosides for broader coverage, combined with local surveillance and antimicrobial stewardship, is essential to preserve treatment options and protect graft function.
Keywords:
urinary tract infection
kidney transplantation
antimicrobial resistance
multidrug resistance
<i>Escherichia coli</i>
<i>Klebsiella pneumoniae</i>
<i>Pseudomonas aeruginosa</i>
antimicrobial stewardship
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