Molecular Assessment of Microbial Etiology in Urinary Tract Infection in Renal Transplant Patients with Fever

The most common source of infection in renal transplant patients is urinary tract infection (UTI) that may cause wide ranges of complications in this critical group; thus, finding microbial etiology of urinary tract infection is important. The aim of current study was to define microbiological etiology of urinary tract infection in renal transplant patients with fever using polymerase chain reaction (PCR) technique, due to higher accuracy and less needed time in comparison to culture, for the first time in Iran.
This was census cross-sectional study on 82 renal transplant patients referred to the hospitals affiliated to Isfahan University of Medical Sciences, Iran, during the years 2015-2017. All patients who had undergone renal transplantation and had fever were included. Midstream morning urine was sent for real-time polymerase chain reaction and urine culture to identify Escherichia coli, Klebsiella pneumoniae, Enterococcus faecalis, and Staphylococcus aureus.
Findings: Urine cultures were positive in 29.3% of patients. Urine polymerase chain reaction was positive in 48.8% of patients, 35% of them for Escherichia coli, 20% for Klebsiella pneumonia, and 45% for Enterococcus faecalis. History of previous infection was statistically related to Enterococcus faecalis positive polymerase chain reaction (P = 0.040). Microorganisms detected by polymerase chain reaction were not in significant association with history of intensive care unit (ICU) admission, or type of immunosuppressant remedy.
Based on findings of our study, using polymerase chain reaction for assessment of urinary tract infection in patients with history of renal transplantation is recommended, due to higher rate of positive results, and less needed time of preparation in comparison to urine culture. Our epidemiological findings showed Enterococcus faecalis as a nosocamial infection as the most prevalent organism detected through real-time polymerase chain reaction panel.