Urine Bacteriology in Post-Kidney Transplant Patients with Double-J Stents

  • S Abu
  • MC Igbokwe
  • OO Olatise
  • M Okafor
  • SO Asaolu
  • AR Adetunbi
Keywords: Bacterial colonisation, End-Stage Renal Disease, DOuble-J, Ureteric Stenting, Urinary Tract Infection


Background: Kidney transplantation is the gold standard treatment modality for patients with end-stage renal disease. Ureteric stenting is commonly used during kidney transplantation to reduce the incidence of ureteric complications post-transplantation. The presence of ureteric stents could be complicated by bacterial colonisation and urinary tract infections.

Objective: To identify the urinary flora in patients with double-J stents following kidney transplantation and establish bacteria colonisation and their antimicrobial susceptibility.

Methods: Over one-year, single urine samples of consecutive 100 post-renal transplant patients were subjected to bacteriologic analysis. Early morning midstream urine was obtained into a sterile bottle from all the participants for laboratory analysis.

Results: The mean age of post kidney transplantation patients was 47.6 ±12.3 years. Hypertension and diabetes were the commonest co-morbidities associated with End-Stage-Renal-Disease (ESRD), accounting for 61% and 28%, respectively. E. coli was the commonest isolate (70.4%). Microbiological evidence of Urinary Tract Infection (UTI) revealed by pyuria (pus cells >4/HPF) was found in 40.9%. Tigecycline, nitrofurantoin and tetracycline showed the highest sensitivity pattern in 9%, 8% and 8%, respectively, with significant resistance against cephalosporins and fluoroquinolones.

Conclusion: The fourth week of double-J ureteric stent insertion in kidney transplant recipients showed a high incidence of urinary bacterial colonisation.


Garcia GG, harden P, Chapman J. the global role of kidney transplantation. Am J Nephrol 2012; 35: 259-264. https://doi.org/10.5812/nephropathol.7448

Salako AA, Badmus TA, Igbokwe MC, David RA, Laoye A, Akinbola IA, et al. Experience with arteriovenous fistula creation for maintenance hemodialysis in a tertiary hospital in South-western Nigeria. Saudi J Kidney Dis Transpl 2018; 29: 924-929. https://doi.org/10.4103/1319-2442.239628

Jha V. Current status of end-stage renal disease care in South Asia. Ethn Dis 2009; 19; 27-32.

Dulal RK, Karki S. Nepalese kidney transplant recipient in a follow-up clinic: related and unrelated living donor. J Nepal Med Assoc 2008; 47: 98-103.

Enns J, Aryal G. A path to renal transplantation in Nepal. J Pathol Nepal 2011; 1: 52-55.

Veroux M, Giuffrida G, Corona D, Gagliano M, Scriffignano V, Vizcarra D. Infective complications in renal allograft recipients: Epidemiology and outcome. Transplantation Proc 2008; 40: 1873-1876. https://doi.org/10.1016/j.transproceed.2008.05.065

Golębiewska J, Dębska-Ślizień A, Komarnicka J, Samet A, Rutkowski B. urinary tract infections in renal transplant recipients. Transplantation Proc 2011; 43: 2985-2990. https://doi.org/10.1016/j.transproceed.2022.07.010

Shohab D, Khawaja A, Atif E, Jamil I, Ali I, Akhter S. Frequency of occurrence of urinary tract infection in double J stented versus non-stented renal transplant recipients. Saudi J Kidney Dis Transpl 2015; 26: 443-446. https://doi.org/10.4103/1319-2442.157298

Kirnap M, Boyvat F, Torgay A, Moray G, Yildirim S, Haberal M. Incidence of urinary complications with Double J Stents in Kidney Transplantation. Exp Clin Transplant 2019; 1: 148-152. https://doi.org/10.6002/ect.MESOT2018.P14

Indu KN, Lakshminarayana G, Anil M. Is early removal of prophylactic ureteric stents beneficial in live donor renal transplantation? Indian J Nephrol 2012; 22: 275-279. https://doi.org/10.4103/0971-4065.101247

Shabeena KS, Bhargava R, Manzoor MAP, Mujeeburahiman M. Characteristics of bacterial colonisation after indwelling double-J ureteral stents for different time duration. Urol Ann 2018; 10: 71-75. https://doi.org/10.4103/UA.UA_158_17

Igbokwe MC, Abu S, Aremu A, Olatise O, Okafor M. Spectrum of Endo-urological procedures performed at a Nigerian Kidney Transplant Centre. Yenagoa Med J 2020; 2: 1-6.

Igbokwe M. Experience and early outcomes of Kidney Transplantation in a Nigerian Transplant in a Nigerian Transplant Institution: A 1-Year Review. 40th Congress of the Societe Internationale D’Urologie; montreal, Canada: SIU Academy; 2020. pSP-18.02. https://doi.org/10.13140/RG.2.2.30933.14562

Tavakoli A, Surange RS, Pearson RC, Parrott NR, Augustine T, Riad HN. Impact of stents on urological complications and health care expenditure in renal transplant recipients: Results of a prospective, randomised clinical trial. J Urol 2007; 177: 2260-2264. https://doi.org/10.1016/j.juro.2007.01.152

Arogundade FA. Kidney transplantation in a low-resource setting: Nigeria Experience. Kidney Int Suppl 2013; 3: 241-245. https://doi.org/10.1038/kisup.2013.23

Ulasi II, Ijoma CK. The enormity of chronic kidney disease in Nigeria: the situation in a teaching hospital in southeast Nigeria. J Trop Med 2010; 2010.501957. https://doi.org/10.1155/2010/501957

Joshi R, Singh DR, Sharma S. Lower urinary tract infection and bacterial colonisation in patients with Double-J ureteral stent. J Nepal Health Res Counc 2011; 9: 165-168.

Kehinde EO, Rotimi VO, Al-Hunayan A. Bacteriology of urinary tract infection associated with indwelling J ureteral stents. J Endourol 2004; 18: 891-896. https://doi.org/10.1089/end.2004.18.891

Kozyrakis D, Perikleous S, Chatzistamou Z-E, Kateris D, Soukias G, Karatzas A, et al. Is there a role for Double J stent culture in contemporary urology? Urol Int 2018; 100: 203-208. https://doi.org/10.1159/000486798

Nzalie RN-t, Gonsu HK, Koulla-Shiro S. Bacterial etiology and antibiotic resistance profile of community-acquired urinary tract infections in a Cameroonian city. Int J Microbiol 2016; 2016: 3240268. https://doi.org/10.1155/2016/3240268

Ahmed SS, Shariq A, Alsalloom AA, Babikir IH, Alhoumoud BN. Uropathogens and their antimicrobial resistance patterns: Relationship with urinary tract infections. Int J Health Sci 2019; 13: 48-55.

Original Research