*Purpose: Urinary tract infections (UTI) occur frequently in renal transplant (RT) recipients. Antimicrobial prophylaxis may help prevent UTI early post RT. Trimethoprim/sulfamethoxazole (TMP/SMX) is the standard of care (SOC) to prevent Pneumocystis jirovecci pneumonia and UTI. Patients intolerant to TMP/SMX receive an alternative regimen with antimicrobial activity consisting of either cephalexin or ciprofloxacin for 1 month. The purpose of this study is to evaluate the efficacy of alternate antimicrobial prophylaxis regimens to prevent UTI in RT recipients.

*Methods: This is a single-center retrospective cohort study of patients ≥18 years old who received a RT between June 1, 2015 and June 30, 2018. Multi-organ transplant recipients, HIV-infected individuals, and patients who received antimicrobials for other infections prior to procedure or post-transplantation were excluded. The SOC group received TMP/SMX daily for the first month. Patients in the alternate group received either cephalexin or ciprofloxacin for the first month. The primary outcome was the incidence of UTI 1 month post RT. Secondary outcomes included UTI incidence at 2 and 3 months post-transplant, incidence of recurrent UTI, median time to first UTI, and pathogens and susceptibility patterns.

*Results: A total of 220 patients were analyzed (200 in SOC and 20 in alternative). There was a lower incidence of UTI at month 1 in the alternative group compared to SOC (5% vs 12.5%, p=0.32). The UTI incidence at months 2 and 3 were (20% vs. 7.5% p=0.058, and 30% vs 1%, and p<0.001) respectively. There was a higher incidence of recurrent UTI post-RT within 3 months (15% vs. 1.5%, p=0.012) and a longer median time to first UTI in the alternative group (46 days vs. 17 days, p=0.003). Escherichia coli (E. coli) was the most common pathogen found in the SOC group. Resistance to TMP/SMX was observed for all E. coli, Enterobacter and Klebsiella isolates in the SOC group. Antimicrobial resistance patterns were consistent with our institution’s antibiogram.

*Conclusions: There was no statistical difference in the incidence of UTI between the SOC or alternative regimens during the first month. However, there was a higher incidence of recurrent UTI within 3 months of KT following discontinuation of prophylaxis as well as a longer time to first UTI with the alternative regimens suggesting an antimicrobial suppressive effect of the alternative antimicrobials.

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