Abstract
Background Urinary tract infection (UTI) poses a significant threat to renal allograft recipients, jeopardizing graft function and patient survival. This study aimed to investigate the incidence, clinical manifestations, microbiological profile, risk factors, and impact of UTI on renal allograft outcomes.Methods A retrospective cohort study was conducted at a tertiary care center in Assam, India, from July 2022 to January 2024, including 220 renal allograft recipients aged over 18 years. Detailed clinical, microbiological, and outcome data were collected and analyzed using SPSS. Multivariate logistic regression was performed to identify independent risk factors.Results The incidence of UTI was 25%, with a higher prevalence in females (58%). Asymptomatic bacteriuria (45%) and cystitis (35%) were the most common UTI types. Escherichia coli (44%) and Klebsiella pneumoniae (32%) were the predominant uropathogens, with 12% of isolates being multi-drug resistant (MDR) and 7% pan-drug resistant (PDR). Female gender (OR 6.73, 95% CI 4.53–12.65, p < 0.001), Prolonged Foley's catheterization (OR 3.92, 95% CI 2.95–4.88, p = 0.019), and Urinary tract abnormalities (OR 2.83, 95% CI 1.61–4.17, p = 0.027) emerged as significant independent risk factors. UTI led to graft failure in 54% of cases, and 3% underwent graft nephrectomy. However, 66% of patients with acute graft dysfunction due to UTI achieved complete recovery with management.Conclusions This study revealed a substantial 25% incidence of urinary tract infection among renal allograft recipients, with the highest risk observed in the early post-transplant period, especially within the first 3 months. Asymptomatic bacteriuria was the most common presentation, and Escherichia coli and Klebsiella pneumoniae were the predominant uropathogens, with a considerable proportion exhibiting multidrug and pan-drug resistance. Female gender, prolonged Foley's catheterization, and urinary tract abnormalities were identified as independent risk factors for UTI development. These findings emphasize the need for heightened vigilance, prompt diagnosis, tailored treatment approaches, and targeted preventive strategies to mitigate the burden of UTIs and combat antimicrobial resistance in this high-risk population.