Background: Enterobacteralesare often responsible for urinary tract infection (UTI) in kidney transplant recipients. Among these,Escherichia coliorKlebsiella speciesproducing extended-spectrum beta-lactamase (ESBL) are emerging. However, there are only scarce data on frequency and impact of ESBL-UTI on transplant outcomes.

Methods: We investigated frequency and impact of first-year UTI events with ESBLEscherichia coliand/orKlebsiella speciesin a prospective multicenter cohort consisting of 1,482 kidney transplants performed between 2012 and 2017, focusing only on 389 kidney transplants having at least one UTI withEscherichia coliand/orKlebsiella species. The cohort had a median follow-up of four years.

Results: In total, 139/825 (17%) first-year UTI events in 69/389 (18%) transplant recipients were caused by ESBL-producing strains. Both UTI phenotypes and proportion among all UTI events over time were not different compared with UTI caused by non-ESBL-producing strains. However, hospitalizations in UTI with ESBL-producing strains were more often observed (39% versus 26%,p = 0.04). Transplant recipients with first-year UTI events with an ESBL-producing strain had more frequently recurrent UTI (33% versus 18%,p= 0.02) but there was no significant difference in one-year kidney function as well as longer-term graft and patient survival between patients with and without ESBL-UTI.

Conclusion: First-year UTI events with ESBL-producingEscherichia coliand/orKlebsiella speciesare associated with a higher need for hospitalization but do neither impact allograft function nor allograft and patient survival.