Urinary tract infection (UTI) is a frequent infectious complication in kidney transplant recipients (KTRs). Antibiotic resistance is common among urine bacterial isolates in this population. Fosfomycin has activity against many antibiotic resistant gram negative organisms, but data on its use in KTRs are limited. Prior studies have shown variable rates of UTI resolution and persistence in KTRs receiving fosfomycin. We compare persistence and resolution of UTI in KTRs treated with fosfomycin or other antibiotics.

We retrospectively reviewed KTRs with UTI between July 2010 and July 2015 at NYU Langone Health. Resolution, defined as no new infection with the same organism within 2 weeks of treatment, and persistence, defined as infection with the same organism within 2 weeks of treatment, was compared between fosfomycin and other antibiotics using Chi-square and univariate logistic regression. Antibiotic resistance was defined as ESBL-producing gram-negative organisms and vancomycin-resistant Enterococcus species.

25 patients had 97 episodes of UTI. 96.9% had resolution and 3.1% had persistence. E. coli was the most common pathogen (34%) followed by Klebsiella (15%) and Enterococcus (14%). 52% of E. coli isolates, 53% of Klebsiella and 50% of Enterococcus were antibiotic resistant. Fluoroquinolones were the most commonly used class of antibiotics (40 cases, 41%); oral beta-lactams and IV antibiotics were used for 14 UTIs (14%) each. 67 out of 79 cases treated with antibiotics other than fosfomycin had resolution (84.8%). Fosfomycin treatment was used in 10 cases (10.3%), all of which had UTI resolution (Chi-square 1.756, p-value = 0.185). Fosfomycin suppression was used in 7 cases (7.2%) with one breakthrough infection. Ciprofloxacin suppression was used in 3 cases with no breakthrough infection. No variable was associated with UTI resolution.

In this study of KTRs, fosfomycin had similar rates of UTI resolution and persistence as other antibiotics. Its low cost, simple dosing regimen and oral administration make fosfomycin a viable alternative for antibiotic resistant UTIs, which confer higher risk of persistence than drug susceptible UTIs. Research into the use of fosfomycin for long-term prophylaxis in KTRs with recurrent UTI is warranted given high rates of persistence and reinfection, and close monitoring for emergence of fosfomycin-resistant UTIs is needed.

CITATION INFORMATION: Mgbako O., Ha J-.E., Topilow N., Min E., Taupin D., Tatapudi V., Gelb B., Hochman S. Fosfomycin vs Other Antibiotics for UTI after Kidney Transplant Am J Transplant. 2017;17 (suppl 3).

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