Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Trimethoprim/sulfamethoxazole (TMP/SMX) is used in kidney transplant patients for prophylaxis against Pneumocystis jiroveci pneumonia (PJP) and has demonstrated a decrease in the incidence of UTIs. The Kidney Disease Improving Global Outcomes Clinical Practice Guidelines recommend use of TMP/SMX for a minimum of six months post-transplant. For patients allergic to TMP/SMX, an alternative agent with additional UTI prophylaxis is recommended. This study aims to identify whether patients receiving an alternative agent for PJP without additional UTI prophylaxis are at higher risk of UTIs than patients receiving TMP/SMX.
*Methods: This single center retrospective chart review included adult kidney transplant patients who received a transplant from 1/1/2013 to 9/30/2018. The primary objective was to determine the rate of UTIs, defined as treatment of a UTI, in the first year post-transplant for patients who received TMP/SMX versus an alternative agent. Descriptive statistics included mean (SD) and N (%) with Student’s T test for continuous variables and Fisher’s exact test for categorical variables. Logistic regression assessed factors associated with UTI.
*Results: Of the 246 patients identified, 240 patients met inclusion criteria. TMP/SMX was used in 215 (89.6%) patients. Forty-seven patients had UTIs, 14 males and 33 females. Of the 47 patients, 37 (78.2%) were on TMP/SMX prophylaxis. After univariable logistic regression, male gender showed a significantly lower risk (OR 0.23, P<0.001) and non-TMP/SMX prophylaxis showed a significantly higher risk for UTI (OR 3.21, P<0.009). After adjusting for other factors, non-TMP/SMX was not independently associated with higher risk (aOR 2.34, P=0.087), while male gender was independently associated with a lower risk of UTI (aOR 0.26, P<0.001).
*Conclusions: Our results show that patients receiving an alternative agent for PJP prophylaxis without additional UTI prophylaxis results in a non-statistically significant increase in the risk of UTI in the first year post-transplant as compared to use of TMP/SMX. Due to the limited sample size, further studies are necessary to confirm these results.
To cite this abstract in AMA style:Laird LC, Nygaard RM, Anderson-Haag TL, Spenningsby AM, Stahler PA. Rates of Urinary Tract Infections in Kidney Transplant Patients Using Trimethoprim/Sulfamethoxazole versus Alternative Agents for Pneumocystis Jiroveci Prophylaxis [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/rates-of-urinary-tract-infections-in-kidney-transplant-patients-using-trimethoprim-sulfamethoxazole-versus-alternative-agents-for-pneumocystis-jiroveci-prophylaxis/. Accessed October 27, 2020.
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