Evaluation of an Antibiotic Strategy for Ureteral Stent Removal After Kidney Transplant.

BACKGROUND AND

OBJECTIVE

This study evaluates the effectiveness of a urine culture (UC)-guided antibiotic strategy in preventing urinary tract infections (UTIs) following ureteral stent (US) removal in kidney transplant recipients.

METHODS

This prospective, single-center cohort study included kidney transplant recipients undergoing cystoscopic US removal. A three-phase protocol was implemented: (1) preprocedure UC screening and UC-guided treatment, (2) US removal with UC and a microbiological analysis of the proximal and distal coils, and (3) postprocedure monitoring for UTI development. The primary outcome was UTI incidence within 48 hours and 1 month after the procedure.

KEY FINDINGS AND LIMITATIONS: The study included 137 patients (median age: 55.8 yr, interquartile range: 15.0). Preprocedure UC screening was positive in 19.7% (n = 27), and 86.9% (n = 119) received amoxicillin/clavulanic acid. US cultures showed a high prevalence of Gram-positive bacteria, including Enterococcus faecalis and Staphylococcus epidermidis. No UTIs were reported within 48 hours after the procedure, and 8.8% (n = 12) developed UTIs within 1 month. Notably, none of the UTIs were culture concordant with prior UC or US cultures. Longer bladder catheterization (>5 days) was significantly associated with US colonization at both the proximal (p = 0.009) and the distal (p < 0.001) coil.

CONCLUSIONS AND CLINICAL IMPLICATIONS: A UC-guided approach appears effective in reducing UTIs after US removal in kidney transplant recipients.

PATIENT SUMMARY: Implementation of a urine culture-based antibiotic strategy before ureteral stent removal in kidney transplant recipients significantly decreases the incidence of postprocedural urinary tract infections. Additionally, patients with bladder catheters in place for >5 days faced a notably higher risk of stent colonization, emphasizing the importance of timely catheter removal.