Recurrent UTIs Linked to QOL Burden in Kidney Transplant Recipients

New research suggests recurrent urinary tract infections (rUTIs) are common in kidney transplant recipients and pose significant implications for morbidity and adverse quality of life.1

These findings highlight the importance of proactively approaching risk factors, optimizing graft function, and implementing infection control measures to minimize the burden of rUTIs on kidney transplant recipients, specifically the disproportionate impact on the female patient population.1

“We believe that our paper is the first to measure the psychosocial burden of rUTIs in KTRs. We found a substantial negative impact on all five aspects assessed in the Recurrent UTI Impact Questionnaire (RUTIIQ) survey,” wrote study investigator Saima Aslam, MD, an infectious disease specialist and, a professor of medicine at the UC San Diego School of Medicine, and colleagues. “High levels of anxiety related to social interactions and impact on sex life were found, along with significant impairment of work and daily activities, highlighting the broader socioeconomic implications of rUTIs on patients' lives.”1

To assess this psychosocial burden, investigators conducted a single-center, retrospective chart review and patient survey of adult kidney transplant recipients ≥ 18 years of age with rUTI at the University of California San Diego Health System. Aslam and colleagues defined rUTI as the ≥ 2 symptomatic UTI in 6 consecutive months or ≥ 3 symptomatic UTI in a year, and multidrug-resistant organisms (MDRO) as organisms with resistance to ≥3 antibiotic classes.1

They adopted the RUTIIQ, a 30-item comprehensive, patient-centred questionnaire used to quantify psychosocial challenges associated with rUTI, with a scoring system across 5 domains: patient satisfaction, work and activity interference, social well-being, personal well-being, and sexual well-being. Participants used a 10-point Likert scale ranging from 1 (“strongly disagree”) to 10 (“strongly agree”) to rate their level of agreement with each question.1,2

Investigators identified a cohort of 46 kidney transplant recipients with a median age of 59.5 years, highlighting that 82.6% of impacted patients were women. Of the population, 84.8% had undergone a single kidney transplant, with 73.9% from deceased donors. The median time since the patient’s most recent transplantation was 50.1 months, and a majority were receiving medication for maintenance immunosuppression.1

The median number of UTIs during the study period was 3 (interquartile range [IQR], 2-5), and 54.3% of predominant uropathogens were E. coli, 43.5% were K. pneumoniae, while 37% of patients had MDROs. Investigators noted an increased rate of hospital admissions and intravenous antibiotics among these patients. Specifically, 65% of patients (n = 30) required hospital admission for UTI management within the 1-year study period, and 69.6% received IV antibiotics (n = 32).1

Evaluating allograft function in 42 eligible patients, 57.1% had >1 episode of acute kidney injury (n = 24) at the time of the UTI event. For the whole cohort, 60.9% of patients had chronic kidney disease. Median tacrolimus trough level was 8.55 ng/mL (IQR 6.6–9.2), positive donor-specific antigen was present in 16.3% of 43 patients, and BK viremia was detected in 13.7% of 44 patients.1

The quality of life survey was answered by 58.7% of participants (n = 27), with median scores showcasing significant personal and social impacts caused by rUTI. Psychological distress was recorded by scores of 7 for “increased anxiety” and 5 for “disrupted sleep” in respondents. In terms of social detriments, patients reported scores of 5 for “avoiding social interactions” and 4 for “feeling embarrassed in social situations”. Notably, patients answered a score of 9 for “regularly missing work or home responsibilities due to UTI” and 8.5 for “significant anxiety about the impact of UTI on their sex life”.1

Investigators called attention to patients’ responses to healthcare-centered satisfaction. While patients reported median scores of 9 for “high satisfaction with the content of medical care”, they also reported a lower score of 4 for “feeling listened to by healthcare providers” and 3 for “ease of access to medical specialists”. According to study investigators, these findings underscore this patient population's desire for psychosocial healthcare integration.1

“In conclusion, we note that rUTI significantly impacts KTRs with a high degree of morbidity and adverse QOL, with female recipients bearing a disproportionate burden,” investigators concluded. “Future research efforts focused on elucidating the underlying mechanisms of rUTI pathogenesis, conducting rigorous therapeutic clinical trials, and developing personalized preventive strategies are essential for improving outcomes in this vulnerable patient population.”1

References

1. Jung S, Chen K, Kazim M, Shah M, Brubaker AL, Aslam S. Pilot Study to Assess the Impact of UTI Recurrence on Quality of Life and Medical Utilization in Kidney Transplant Recipients. Transplant Infectious Disease. Published online November 25, 2025. doi:https://doi.org/10.1111/tid.70137

2. Emil. RUTIIQ | The Recurrent Urinary Tract Infection Impact Questionnaire. PARED Insights. Published June 11, 2024. Accessed December 4, 2025. https://paredinsights.org/assessment-tools/rutiiq/