Asymptomatic Bacteriuria & Risk of Urinary Tract Infection in Renal Transplants
Asymptomatic Bacteriuria & Risk of Urinary Tract Infection in Renal Transplants
The goal of this research program is to understand the natural history of asymptomatic
 bacteriuria in the renal transplant patients, to determine if screening for asymptomatic
 bacteriuria and identification of key host characteristics and virulence factors present on
 uropathogenic bacteria identifies a sub-population of patients with asymptomatic bacteriuria
 that are at risk to develop symptomatic urinary tract infection. Ultimately, the knowledge
 obtained from this study will prevent inappropriate antibiotic use and may identify whether
 certain bacterial isolates predispose to renal allograft injury. We will test the hypothesis
 that (i) asymptomatic bacteriuria is common in the renal allograft recipient and (ii) that
 symptomatic urinary tract infection and renal allograft dysfunction do not occur unless key
 host susceptibility factors and uropathogenic bacterial virulence factors are present.
Blood samples and urine cultures will be obtained from asymptomatic renal transplant clinic
 patients. If the urine culture is positive (> or = 105 cfu/ml), we will determine the host
 and bacterial virulence factors associated with asymptomatic bacteriuria (ASB) and compare
 these results to transplant patients that develop a symptomatic UTI. The patient's clinical
 information, laboratory data and the bacterial isolate responsible for the UTI will be
 collected at the time of their clinic visit and subsequently analyzed.

 After the first visit (Day 0 after signing consent) blood and urine will be collected,
 subjects will be put into either ASB Positive or ASB Negative groups based upon the results
 of their urine culture. From that point, those who test into the ASB Negative group will have
 an additional urine culture, either by returning to the clinic or by sending a urine culture
 mailer kit, and if cultures remain negative, they will be discharged from the study after
 reviewing medications, adverse events and completing a urinary tract infection risk
 questionnaire.

 For those who test into the ASB Positive group, those subjects will be monitored by the
 subject returning to the clinic on Day 10-14, at 1 month, 2 month, 3 month and 6 months for
 blood and urine collection, review of medications and adverse events, and completing a
 urinary tract infection risk questionnaire. Should the subject have symptoms of a UTI, the
 subject will be treated with the appropriate antibiotic for which the bacterial isolated from
 their urine culture is sensitive. Patients will return to the clinic 10-14 days later for a
 repeat urine culture, complete a urinary tract infection risk questionnaire, and have a
 repeat urine culture to confirm they are urinary tract infection free. At this point, the
 subject will be discharged from the study after reviewing medications and adverse events.

 It is predicted that 75% of patients will test into the ASB Negative Group and do not require
 antibiotic therapy. We predict that 25% of patients will test into the ASB Positive Group,
 but that less than 5% of these patients will ultimately develop a symptomatic UTI and require
 antibiotic treatment.
Inclusion Criteria:

 -  must be 18 years old or older,

 -  had a kidney transplant,

 -  be at least 30 days post operation.

 Exclusion Criteria:

 -  Pregnant women, those planning to become pregnant or nursing mothers;

 -  Renal transplant patients less than 30 days post transplant; Use of an indwelling
 Foley catheter;

 -  Patients without a renal transplant;

 -  Patients having concurrent surgical/wound infection and presumed hematogenous
 dissemination for the urinary tract.