Wound infections in renal transplant recipients--a complication of urinary tract infections during allograft malfunction.

Both wound and urinary tract infections are common in renal transplant recipients. Certain recipients, however, develop detrimental complications following such infections, and our aim was to analyze factors that predisposed recipients to such complications. Analysis of 174 consecutive transplants performed over a 7-year period ending December 1980 demonstrated that a urinary infection developing during acute tubular malfunction (ATM) led to serious septic complications. The complication rate was 70% in the 30 recipients in whom urinary tract infection occurred during ATM but only 10% in the 20 recipients with infection in the absence of ATM (P less than 0.001). Similarly, analysis of 14 deep wound infections showed that the source of the organisms was the urinary tract (12 cases), especially when the urinary tract infection occurred in the setting of ATM. Deep injections led to high rates of morbidity and mortality. Conversely, superficial wound infections (10 cases) contained staphylococci and healed without complications. We suggest that urinary tract organisms, which are difficult to eradicate with antibiotics because of low urinary concentration of antibiotics during ATM, lead to infection of the perirenal tissues.