Abstract
BACKGROUND Kidney transplant recipients require lifelong immunosuppression, predisposing them to bacterial infections that can impair survival. This study evaluated the impact of early bacterial infections on long-term mortality and sought to identify clinical and procedural predictors of infection. MATERIAL AND METHODS This retrospective study included kidney transplant recipients (2014-2024) with ≥12 months of follow-up. Bacterial infections were classified as early (≤6 months) or late (>6 months). Clinical, laboratory, and microbiological data were analyzed. Cox regression analysis identified independent predictors of mortality, and logistic regression determined factors associated with early infections. RESULTS Early bacterial infections occurred in 35.4% of patients and were independently associated with a 3-fold increase in mortality risk (adjusted hazard ratio [aHR]=3.03, 95% CI: 1.42-6.44, P=0.004). Diabetic nephropathy-related end-stage kidney disease (aHR=4.14, P=0.003) and older recipient age (aHR=1.10 per year, P<0.001) were additional independent predictors. The final Cox model demonstrated good discriminative performance (C-index=0.821). Urinary tract infections were most common (67%), followed by bloodstream infections (25%) and pneumonia (10%). Escherichia coli, Klebsiella spp., and Enterococcus spp. predominated. Low albumin and hemoglobin levels and ureteral stent placement were associated with early infection. Infection episodes were treated using antibiogram-guided therapy, and no multidrug-resistant organisms were identified. CONCLUSIONS Early infections and diabetic nephropathy-related ESKD predict long-term mortality after kidney transplantation. Optimizing nutritional status to improve albumin and hemoglobin levels, ensuring careful use and timely removal of ureteral stents, and implementing strict antibiogram-guided antibiotic stewardship can help reduce early infection risk. Targeted early interventions and closer surveillance of high-risk patients may improve long-term outcomes.