Nitrofurantoin Susceptibility and the Landscape of Multidrug-Resistant Gram-Negative Uropathogens in Kidney Transplant Recipients During the First Post-Transplant Year
Abstract
Background: Multidrug-resistant (MDR) Gram-negative urinary tract infections (UTIs) frequently complicate the first post-transplant year in kidney transplant (KTX) recipients. This study characterized patterns of uropathogen susceptibility, MDR prevalence, and predictors of MDR UTI in this population.
Methods: In a single-center retrospective cross-sectional study (KFSHRC, Riyadh; October 2024 to December 2025), 83 adult first-transplant recipients with a first-year Gram-negative UTI were included for analysis. Susceptibility was determined using VITEK 2/CLSI criteria, and MDR was defined according to Magiorakos/ECDC criteria.
Results: Nitrofurantoin susceptibility varied significantly by species, with 89.2% in E. coli compared to 15.0% in K. pneumoniae (p E. coli but not for K. pneumoniae. Carbapenems and amikacin retained near-complete activity, whereas cephalosporins, ciprofloxacin, and trimethoprim-sulfamethoxazole exhibited resistance rates of 45 to 68%. K. pneumoniae (49.4%) and E. coli (44.6%) were the predominant uropathogens, and MDR accounted for 63.9% of episodes (95% CI 53.1 to 73.4). MDR was associated with UTI recurrence, prolonged hospitalization, and reduced microbiological eradication (69.8% vs. 86.7%). UTI recurrence was the only independent predictor of MDR status (adjusted OR, 3.99; 95% CI, 1.46 to 10.89; p = 0.007). No UTI-associated mortality occurred within one year.
Conclusions: Species-directed therapy, such as nitrofurantoin for E. coli and…
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Evidence Hub reads this as a cross-sectional. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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