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.
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 Fishers exact test.
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.
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.
To cite this abstract in AMA style:Wojciechowski D, Chandran S. Ciprofloxacin Combined with SMZ/TMP Prophylaxis Reduces the Incidence of UTIs Following Kidney Transplantation [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/ciprofloxacin-combined-with-smztmp-prophylaxis-reduces-the-incidence-of-utis-following-kidney-transplantation/. Accessed July 30, 2021.
« Back to 2013 American Transplant Congress