Introduction:

Urinary tract infections (UTIs) are major causes of morbidity and recurrent hospitalizations following kidney transplantation. To date there are no guidelines on antibiotic prophylaxis for UTIs in this population.

Methods:

Retrospective single center study comparing sulfamethoxazole/trimethoprim 800/160 mg (SMZ/TMP) daily for 6 months (Group 1, n=106; July-December 2009) vs. SMZ/TMP Monday, Wednesday, Friday (MWF) for six months plus ciprofloxacin 250 mg twice daily for 30 days (Group 2, n=130; January-June 2010) following kidney transplantation. The 1-year incidence of UTIs, time to first UTI, and total number of hospitalizations for UTIs were assessed. Continuous variables were analyzed using the Mann-Whitney test and categorical variables were analyzed using Chi square or Fisher’s exact test.

Results:

Baseline demographics, transplant characteristics, immunosuppression agents, and 1-year rates of acute rejection were similar between the two groups. At 1 year, a significantly higher proportion of patients in Group 1 (SMZ/TMP alone) had developed UTIs (23.6% vs. 10.8%; p=0.013), and the mean time to first UTI for Group 1 was significantly shorter (96.6 ± 79.5 days vs. 168 ± 89.7 days, p=0.01). The proportion of those hospitalized for ≥ 1 UTI was also higher in Group 1 (16.0% vs. 7.7%, p=0.063), approaching statistical significance.

The proportion of first UTIs caused by Enterococcus species was significantly higher in Group 2 (28.6% vs. 4%, p=0.047) with enteric gram-negative bacteria accounting for the remaining infections. There was a similar incidence of antibiotic resistance to enteric gram-negative bacteria in Groups 1 and 2 for SMZ/TMP (75% vs. 80%, p=1.00) and ciprofloxacin (16.7% vs. 30%, p=0.39). For Groups 1 and 2 the proportion of first UTIs with associated bacteremia (16.7% vs. 30%, p=0.39) or requiring hospitalization (48.9% vs. 40.6%, p=0.62) did not differ.

Conclusion:

The addition of a 30-day course of ciprofloxacin prophylaxis to 6 months of SMP/TMZ in kidney transplant recipients reduces the incidence of UTIs and associated morbidity, without significant alterations in patterns of antibiotic resistance or associated complications. Larger scale studies are warranted.

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