Treatment of recurrent urinary tract infections in a 60-year-old kidney transplant recipient. The use of phage therapy

We would like to demonstrate the difficulty of treatment in a patient after kidney transplantation (KTX) who developed chronic urinary tract infection (UTI) with a multi-drug resistant ESBL-producingKlebsiella pneumoniae. The patient underwent several treatment interventions including supportive therapy with bacteriophages. This article presents a case of a 60-year-old patient after KTX repeatedly admitted to the hospital with recurrent UTIs caused by ESBL-producingKlebsiella pneumoniaeshowing variable susceptibility to carbapenems and full susceptibility to colistin only. KTX was performed due to renal insufficiency caused by polycystic kidney disease. The patient experienced 12 severe episodes of UTI due toK pneumoniaewithin 15 months since transplantation. In an attempt to curb the ongoing infections, phage therapy (PT) was applied on the experimental basis, coordinated by the Phage Therapy Unit of the Hirszfeld Institute in Wroclaw, Poland. Eventually, the patient fully recovered following nephrectomy of his own left kidney where cysts were the suspected reservoir of bacteria. The patient completed 29 days of PT. PT caused no reported side effects in the described case of the KTX recipient, although its role in controlling chronic UTI caused byK pneumoniaeis unclear. More studies are needed in the population of kidney transplant recipients.

Automated summary

This article presents a case of a kidney transplant recipient who experienced recurrent urinary tract infections caused by multi-drug resistant ESBL-producing Klebsiella pneumoniae. Despite undergoing multiple treatment interventions, the patient fully recovered after nephrectomy and phage therapy. Further studies are needed to understand the role of phage therapy in controlling chronic UTIs in kidney transplant recipients.