Background: Urinary tract infection (UTI) is the most common infectious complication after kidney transplantation resulting in increased morbidity and mortality. Sulfamethoxazole[mdash]trimethoprim (SMX-TMP) is commonly used as Pneumocystisjiroveci pneumonia (PJP) prophylaxis following kidney transplant and covers common urologic pathogens. The objective of this study was to evaluate the impact of PJP prophylaxis on the incidence of treated UTI's within the first year of kidney transplant at an academic medical center. Methods: This was a single-center retrospective cohort study that excluded previous transplant and multiple-organ recipients. Patients who remained on prophylaxis with SMX-TMP for at least 30 days after transplant were compared to patients who were switched to alternative PJP prophylaxis with dapsone or atovaquone within 30 days of transplant. Results: One hundred and fifty-five patients who received a kidney transplant between January 1, 2015 and October 31, 2016 were included. One hundred and thirteen patients received PJP prophylaxis with SMX-TMP for at least 30 days following transplant (group 1). Forty two patients were switched to alternative prophylaxis within 30 days of transplant (group 2). Five patients did not receive SMX-TMP due to pre-existing sulfa allergies, and 30 patients were switched to alternative agents due to increased serum creatinine, including 10 patients with delayed graft function. Less common reasons for SMX-TMP discontinuation included hyperkalemia, leukopenia, increased transaminases, and GI upset. Seventy eight total treated UTI's were reported in group 1 and 30 treated UTI's were reported in group 2 (p=0.9317). Thirty seven patients in group 1 and 13 patients in group 2 were treated for at least one UTI event (32.7% vs 30.9%, p= 0.8334). Six urosepsis events were recorded within the first year of transplant in group 1, vs 3 urosepsis events in group 2 (5.3% vs 7.1%, p= 0.6987). No death censored graft loss was found in either group. No cases of PJP were reported within the one year prophylaxis period in either group. Conclusion: No difference in the number of treated UTI's was found between patients who remained on SMX-TMP prophylaxis for at least 30 days after transplantation vs those who were switched to alternative PJP prophylaxis within 30 days of transplant. SMX-TMP can be safely discontinued as no cases of PJP were reported within the one-year prophylaxis period.

CITATION INFORMATION: Sanchez S., Brokhof M., Kenyon N., Varughese C., Alvey N. Impact of Pneumocystis Prophylaxis on Incidence of Treated Urinary Tract Infections Following Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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