Efficacy of a Single Dose of Intravesical Aminoglycoside for the Prevention of Urinary Tract Infections in Kidney Transplant Recipients

INTRODUCTION: Urinary tract infections (UTIs) occur commonly following kidney transplant and are associated with significant morbidity. Some providers perform intra-operative antibiotic bladder irrigation at the time of ureteroneocystostomy, although practice varies widely among surgeons. As a result, this study was performed to assess outcomes following a single intravesical gentamicin injection for the prevention of UTIs. METHODS: This was a retrospective cohort study of adult patients who underwent a first isolated kidney transplant between January 2018 and January 2023. Outcomes were compared between patients who received bladder irrigation with a single dose of gentamicin and controls who did not receive antibiotic irrigation. The primary end point was the incidence of culture-confirmed UTI within 3-months of transplant. Key secondary endpoints included delayed allograft function and serum creatinine at 3-months. RESULTS: A total of 764 patients were included in the study analysis (gentamicin = 406 vs. control = 358). At 3 months, the incidence of UTIs was 18.2% in the gentamicin group compared to 13.1% in the control group (p = 0.05). A higher incidence of BK viremia >10,000 copies/mL was also observed in the gentamicin group compared with control patients (5.9% vs. 2.5%; p = 0.02). After multivariable regression analysis older age, female sex, early rejection, longer dialysis vintage, and urinary catheter duration were all found to be positively correlated with the incidence of UTIs. CONCLUSION: Among kidney transplant recipients, bladder irrigation with gentamicin was not found to reduce the incidence of UTIs at 3 months. Additional studies should explore a possible association between antibiotic bladder irrigation and subsequent BK viremia.