{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T05:02:20Z","timestamp":1790744540599,"version":"4.1.0"},"reference-count":59,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The aim of the study was to verify how the kidney transplant (KTx) recipient profile changed between 2013 and 2022 and whether these changes influence the incidence, clinical manifestations, and microbiology of urinary tract infections (UTIs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and methods<\/jats:title>\n                    <jats:p>We analyzed clinical data and urine cultures collected during the first posttransplant year in patients who underwent KTx between January 2013 and December 2022.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We studied data from 491 patients, who developed 448 episodes of UTIs, including asymptomatic bacteriuria (n=211, 47%), lower UTIs (n=80, 18%), acute graft pyelonephritis (n=97, 22%) and urosepsis (n=60, 13%). During two 5-year time periods (2013\u20132017 and 2018-2022), the number of recipients aged 70 years or over and 75 years or over increased (p=0.07). Recipients receiving a transplant more recently had higher numbers of mismatching HLA (p=0.001) and maximum CDC-PRA (p=0.001). As a result, in 2018\u20132022 KTx recipients were more likely to receive induction therapy vs. no induction and tacrolimus vs. cyclosporine-based maintenance immunosuppression (p&amp;lt;0.001). There was a parallel change in the etiology of UTIs, from\n                      <jats:italic>Escherichia coli<\/jats:italic>\n                      being the predominant pathogen (responsible for almost 35% of all UTI episodes in 2013-2017) to\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      , which was isolated in 45% of all UTI episodes between 2018-2022.\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      increased over calendar time (OR\/year 1.23, 95% CI 1.08\u20131.39; p=0.0018). The proportion of highly resistant strains rose from 40.1% in 2013-2017, to 53.4% between 2018-2022 (p=0.008) and also increased in the linear model (p = 0.0369).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Over the 10-year period, there was a noticeable change in both KTx recipient and uropathogen characteristics, which requires alteration of antimicrobial prophylaxis and treatment strategies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcimb.2026.1831429","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:49:03Z","timestamp":1790743743000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Etiology, incidence and clinical manifestations of urinary tract infections in evolving population of kidney transplant recipients \u2013 a single center 10-year retrospective analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Justyna E.","family":"Go\u0142\u0119biewska","sequence":"first","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krystian","family":"Stefa\u0144ski","sequence":"additional","affiliation":[{"name":"Students\u2019 Scientific Circle, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krzysztof","family":"Pastuszak","sequence":"additional","affiliation":[{"name":"Department of Algorithms and System Modelling, Gda\u0144sk University of Technology","place":["Gda\u0144sk, Poland"]},{"name":"Department of Translational Oncology, Medical University of Gda\u0144sk, Poland","place":["Gda\u0144sk, Poland"]},{"name":"Center of Biostatistics and Bioinformatics, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alicja","family":"D\u0119bska-\u015alizie\u0144","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Transplantology and Internal Medicine, Medical University of Gda\u0144sk","place":["Gda\u0144sk, Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1053\/j.ajkd.2004.04.040","article-title":"Late urinary tract infection after renal transplantation in the United States","volume":"44","author":"Abbott","year":"2004","journal-title":"Am. J. Kidney Dis."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1808","DOI":"10.1016\/j.transproceed.2015.03.046","article-title":"Bacterial infections in renal transplant recipients","volume":"47","author":"Adamska","year":"2015","journal-title":"Transplant. Proc."},{"key":"B3","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1038\/s41585-021-00477-x","article-title":"Molecular determinants of disease severity in urinary tract infection","volume":"18","author":"Ambite","year":"2021","journal-title":"Nat. Rev. Urol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1097\/TP.0B013E3182A049FD","article-title":"Risk factors and outcomes of bacteremia caused by drug-resistant ESKAPE pathogens in solid-organ transplant recipients","volume":"96","author":"Bodro","year":"2013","journal-title":"Transplantation"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1093\/NDT\/GFAD189","article-title":"International comparison and time trends of first kidney transplant recipient characteristics across Europe: an ERA Registry study","author":"Boenink","year":"2024","journal-title":"Nephrol Dial Transplant."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1823","DOI":"10.1111\/AJT.17026","article-title":"Impact of different urinary tract infection phenotypes within the first year post-transplant on renal allograft outcomes","volume":"22","author":"Brune","year":"2022","journal-title":"Am. J. Transplantation:"},{"key":"B7","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J. Chronic Dis."},{"key":"B8","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.jhin.2005.10.018","article-title":"Nosocomial infections in renal transplant patients: risk factors and treatment implications associated with urinary tract and surgical site infections","volume":"63","author":"Dantas","year":"2006","journal-title":"J. Hosp. Infection"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.3389\/FGENE.2015.00353","article-title":"Great desire for extended life and health amongst the American public","volume":"6","author":"Donner","year":"2016","journal-title":"Front. Genet."},{"key":"B10","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1016\/j.idc.2020.08.005","article-title":"Antibiotic-resistant infections and treatment challenges in the immunocompromised host: an update","volume":"34","author":"Dumford","year":"2020","journal-title":"Infect. Dis. Clinics North. America"},{"key":"B11","volume-title":"EAU guidelines on urological infections","year":"2025"},{"key":"B12","volume-title":"European Centre for Disease Prevention and Control (ECDC). Antimicrobial Resistance in the EU\/EEA (EARS-Net) - Annual Epidemiological Report for 2016","year":"2017"},{"key":"B13","volume-title":"European Centre for Disease Prevention and Control (ECDC). Antimicrobial Resistance in the EU\/EEA (EARS-Net) - Annual Epidemiological Report for 2017","year":"2018"},{"key":"B14","volume-title":"European Centre for Disease Prevention and Control (ECDC). Antimicrobial Resistance in the EU\/EEA (EARS-Net) - Annual Epidemiological Report for 2019","year":"2020"},{"key":"B15","volume-title":"European Centre for Disease Prevention and Control (ECDC). Antimicrobial Resistance in the EU\/EEA (EARS-Net) - Annual Epidemiological Report for 2022","year":"2023"},{"key":"B16","doi-asserted-by":"publisher","first-page":"298.e1","DOI":"10.1016\/J.CMI.2021.06.031","article-title":"Bloodstream infections in patients with rectal colonization by Klebsiella pneumoniae producing different type of carbapenemases: a prospective, cohort study (CHIMERA study)","volume":"28","author":"Falcone","year":"2022","journal-title":"Clin. Microbiol. Infection:"},{"key":"B17","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1007\/s00284-016-1121-x","article-title":"MALDI-TOF MS Versus VITEK \u0147 2: Comparison of systems for the identification of microorganisms responsible for bacteremia","volume":"730","author":"Febbraro","year":"","journal-title":"Curr Microbiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"2985","DOI":"10.1016\/j.transproceed.2011.07.010","article-title":"Urinary tract infections in renal transplant recipients","volume":"43","author":"Go\u0142\u0119biewska","year":"2011","journal-title":"Transplant. Proc."},{"key":"B19","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1099\/jmm.0.000942","article-title":"Host and pathogen factors in Klebsiella pneumoniae upper urinary tract infections in renal transplant patients","volume":"68","author":"Go\u0142\u0119biewska","year":"2019","journal-title":"J. Med. Microbiol."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13507","article-title":"Urinary tract infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice","volume":"33","author":"Goldman","year":"2019","journal-title":"Clin. Transplant."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1263","DOI":"10.1111\/CTR.12465","article-title":"Urinary tract infections during the first year after renal transplantation: one center\u2019s experience and a review of the literature","volume":"28","author":"Go\u0142\u0119biewska","year":"2014","journal-title":"Clin. Transplant."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1016\/j.transproceed.2016.01.061","article-title":"Urinary tract infections in kidney transplant recipients hospitalized at a transplantation and nephrology ward: 1-year follow-up","volume":"48","author":"Gozdowska","year":"2016","journal-title":"Transplant. Proc."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2498","DOI":"10.1681\/ASN.2016050543","article-title":"Understanding trends in kidney function 1 year after kidney transplant in the United States","volume":"28","author":"Huang","year":"2017","journal-title":"J. Am. Soc. Nephrology: JASN"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1111\/tid.13852","article-title":"Importance of antimicrobial stewardship in solid organ transplant recipients: An ESCMID perspective","volume":"24","author":"Ioannou","year":"2022","journal-title":"Transplant. Infect. Dis."},{"key":"B25","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1111\/AJT.16106","article-title":"Characterizing the landscape and impact of infections following kidney transplantation","volume":"21","author":"Jackson","year":"2021","journal-title":"Am. J. Transplantation:"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/JOURNAL.PCBI.1008446","article-title":"Identifying the drivers of multidrug-resistant Klebsiella pneumoniae at a European level","volume":"17","author":"Kachalov","year":"2021","journal-title":"PloS Comput. Biol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1186\/s12866-017-1037-z","article-title":"Comparison of biomarker based Matrix Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) and conventional methods in the identification of clinically relevant bacteria and yeast","volume":"17","author":"Kassim","year":"2017","journal-title":"BMC Microbiol."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/FCIMB.2022.861374","article-title":"Urinary tract infections caused by K. pneumoniae in kidney transplant recipients - epidemiology, virulence and antibiotic resistance","volume":"12","author":"Krawczyk","year":"2022","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1007\/S00134-022-06954-0","article-title":"Relationship between immunosuppression and intensive care unit-acquired colonization and infection related to multidrug-resistant bacteria: a prospective multicenter cohort study","volume":"49","author":"Kreitmann","year":"2023","journal-title":"Intensive Care Med."},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1371\/JOURNAL.PONE.0112938","article-title":"Recipient-related risk factors for graft failure and death in elderly kidney transplant recipients","volume":"9","author":"Lai","year":"2014","journal-title":"PloS One"},{"key":"B31","doi-asserted-by":"publisher","first-page":"656","DOI":"10.1016\/J.EKIR.2019.01.014","article-title":"Risk factors for early graft failure and death after kidney transplantation in recipients older than 70 years","volume":"4","author":"Lemoine","year":"2019","journal-title":"Kidney Int. Rep."},{"key":"B32","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1007\/S40121-024-00956-9","article-title":"Impact of immunosuppressed status on prognosis of carbapenem-resistant organisms bloodstream infections","volume":"13","author":"Li","year":"2024","journal-title":"Infect. Dis. Ther."},{"key":"B33","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1111\/AJT.14578","article-title":"Emergency department use among kidney transplant recipients in the United States","volume":"18","author":"Lovasik","year":"2018","journal-title":"Am. J. Transplantation:"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1021\/ACSINFECDIS.8B00158","article-title":"Fitness landscape of the immune compromised favors the emergence of antibiotic resistance","volume":"4","author":"Margolis","year":"2018","journal-title":"ACS Infect. Dis."},{"key":"B35","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1093\/AJE\/KWI068","article-title":"Utility of the chronic disease score and Charlson comorbidity index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms","volume":"161","author":"McGregor","year":"2005","journal-title":"Am. J. Epidemiol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"e897","DOI":"10.1016\/S2468-2667(22)00225-0","article-title":"The burden of bacterial antimicrobial resistance in the WHO European region in 2019: a cross-country systematic analysis","volume":"7","author":"Mestrovic","year":"2022","journal-title":"Lancet Public Health"},{"key":"B37","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet (London England)"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050","volume":"404","author":"Naghavi","year":"2024","journal-title":"Lancet (London England)"},{"key":"B39","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1111\/TRI.12711","article-title":"Clinical and economic consequences of first-year urinary tract infections, sepsis, and pneumonia in contemporary kidney transplantation practice","volume":"29","author":"Naik","year":"2016","journal-title":"Transplant. International: Transpl Int."},{"key":"B40","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1093\/femsre\/fux013","article-title":"Klebsiella pneumoniae: A major worldwide source and shuttle for antibiotic resistance","volume":"41","author":"Navon-Venezia","year":"2017","journal-title":"FEMS Microbiol. Rev."},{"key":"B41","doi-asserted-by":"publisher","first-page":"1846","DOI":"10.1093\/NDT\/GFAE081","article-title":"Better kidney allograft survival despite higher-risk donor and recipient characteristics between 1995 and 2014","volume":"39","author":"Ng","year":"2024","journal-title":"Nephrol Dial Transplant."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1611","DOI":"10.1093\/CID\/CIZ021","article-title":"Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America","volume":"68","author":"Nicolle","year":"2019","journal-title":"Clin. Infect. Diseases:"},{"key":"B43","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1111\/TRI.12984","article-title":"Changing trends in the aetiology, treatment and outcomes of bloodstream infection occurring in the first year after solid organ transplantation: a single-centre prospective cohort study","volume":"30","author":"Oriol","year":"2017","journal-title":"Transpl Int."},{"key":"B44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3390\/microorganisms9112272","article-title":"Carbapenemase-producing klebsiella pneumoniae colonization and infection in solid organ transplant recipients: a single-center, retrospective study","volume":"9","author":"Pagani","year":"2021","journal-title":"Microorganisms"},{"key":"B45","doi-asserted-by":"publisher","first-page":"210259","DOI":"10.1183\/16000617.0259-2021","article-title":"Antibiotic resistance in chronic respiratory diseases: from susceptibility testing to the resistome","volume":"31","author":"Pailhori\u00e8s","year":"2022","journal-title":"Eur. Respir. Review: An. Off. J. Eur. Respir. SocEur Respir Rev."},{"key":"B46","doi-asserted-by":"publisher","first-page":"103310","DOI":"10.1016\/j.eclinm.2025.103310","article-title":"Effectiveness and safety of strategies to optimise antimicrobial use in solid organ transplant recipients. Systematic review and meta-analyses","volume":"85","author":"Paniagua-Garc\u00eda","year":"2025","journal-title":"eClinicalMedicine"},{"key":"B47","doi-asserted-by":"publisher","first-page":"1457","DOI":"10.3904\/KJIM.2019.292","article-title":"Characteristics of kidney transplantation recipients over time in South Korea","volume":"35","author":"Park","year":"2020","journal-title":"Korean J. Internal Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1007\/S40520-020-01558-4","article-title":"Impact of kidney transplant morbidity on elderly recipients\u2019 outcomes","volume":"33","author":"Pravisani","year":"2021","journal-title":"Aging Clin. Exp. Res."},{"key":"B49","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/TP.0000000000000332","article-title":"Graft and patient survival outcomes of a third kidney transplant","volume":"99","author":"Redfield","year":"2015","journal-title":"Transplantation"},{"key":"B50","doi-asserted-by":"publisher","first-page":"284","DOI":"10.3390\/antibiotics9060284","article-title":"Analysis of susceptibility to selected antibiotics in Klebsiella pneumoniae, Escherichia coli, Enterococcus faecalis and Enterococcus faecium causing urinary tract infections in kidney transplant recipients over 8 years: Single-center study","volume":"9","author":"Rostkowska","year":"2020","journal-title":"Antibiotics"},{"key":"B51","doi-asserted-by":"publisher","first-page":"11859","DOI":"10.3389\/ti.2023.11859","article-title":"New approaches to manage infections in transplant recipients: Report from the 2023 GTI (Infection and Transplantation Group) annual meeting","volume":"36","author":"Serris","year":"2023","journal-title":"Transpl Int."},{"key":"B52","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1016\/j.transproceed.2013.02.019","article-title":"Recurrent urinary tract infections in kidney transplant recipients","volume":"45","author":"Silva","year":"2013","journal-title":"Transplant. Proc."},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1038\/S41598-018-31612-1","article-title":"Association of kidney function with infections by multidrug-resistant organisms: An electronic medical record analysis","volume":"8","author":"Su","year":"2018","journal-title":"Sci. Rep."},{"key":"B54","doi-asserted-by":"publisher","first-page":"1978","DOI":"10.3390\/MICROORGANISMS12101978","article-title":"Antibiotic resistance in the elderly: Mechanisms, Risk Factors, and Solutions","volume":"12","author":"Theodorakis","year":"2024","journal-title":"Microorganisms"},{"key":"B55","doi-asserted-by":"publisher","first-page":"A8-A11","DOI":"10.1053\/j.ajkd.2025.02.602","article-title":"US Renal Data System 2024 Annual Data Report: Epidemiology of Kidney Disease in the United States","volume":"85","author":"Johansen","year":"2025","journal-title":"Am J Kidney Dis"},{"key":"B56","doi-asserted-by":"publisher","first-page":"2414","DOI":"10.1016\/j.transproceed.2006.08.018","article-title":"Epidemiology of urinary infections in renal transplant recipients","volume":"38","author":"Valera","year":"2006","journal-title":"Transplant. Proc."},{"key":"B57","doi-asserted-by":"publisher","first-page":"e159","DOI":"10.1093\/CID\/CIZ1113","article-title":"Burden and timeline of infectious diseases in the first year after solid organ transplantation in the Swiss Transplant Cohort Study","volume":"71","author":"Van Delden","year":"2020","journal-title":"Clin Infect Dis."},{"key":"B58","doi-asserted-by":"publisher","first-page":"1755","DOI":"10.1007\/S15010-025-02493-0","article-title":"Antibiotic resistance of urinary pathogens after kidney transplantation: a 10-year single-center survey in Germany","volume":"53","author":"Weber","year":"2025","journal-title":"Infection"},{"key":"B59","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1186\/S13613-024-01314-1","article-title":"Immunosuppression at ICU admission is not associated with a higher incidence of ICU-acquired bacterial bloodstream infections: The COCONUT study","volume":"14","author":"Zebian","year":"2024","journal-title":"Ann. Intensive Care"}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1831429\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:49:11Z","timestamp":1790743751000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2026.1831429\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":59,"alternative-id":["10.3389\/fcimb.2026.1831429"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2026.1831429","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"1831429"}}