Prophylaxis by trimethoprim-sulfamethoxazole does not reduce the incidence of severe urinary tract infection but facilitates the development of antimicrobial resistance.
R. Singh, S.E. Geerlings, R.J.M. ten Berge, F.J. Bemelman
Moderator(s): M.H.L. Christiaans en E.J.P. de Koning
Location(s): Grote zaal
Category:
Introduction: Urinary tract infections (UTIs) are very common among renal allograft recipients. These UTIs can be severe enough to cause considerably morbidity and hospital admissions. Trimethoprim-sulfamethoxazole (TMP-SMX) as Pneumocystis jirovecii pneumonia (PJP) prophylaxis reduces bacteriuria.
Objectives: 1: To evaluate the risk factors of severe post-transplant UTIs and the influence of TMP-SMX on its incidence. 2: To evaluate the impact of TMP-SMX on the antimicrobial resistance pattern of the causative pathogens.
Methods: Retrospective cohort study consisting of adult renal allograft recipients transplanted between 2004 and 2009 in our university medical center. Severe UTI was defined as a UTI requiring hospital admission. Diagnosis was based on both clinical symptoms and positive urine culture. We analysed only the first severe UTI occurring within the first year after transplantation.
Results: In total 431 renal allograft recipients were followed for 1 year after transplantation. Fifty-six (13%) recipients developed a severe UTI of whom 31 received TMP-SMX. Median time between transplantation and severe UTI was 92 (36-223) days. Multivariable analysis showed that the presence of indwelling urological catheter was the only variable associated with development of severe UTI (OR=5.11, 95%CI=2.40-10.86, p<0.001). This analysis showed that, TMP-SMX prophylaxis did not prevent severe UTI (OR=1.26, 95% CI=0.64-2.51,p=0.50). The most frequent isolated causative pathogen was Escherichia coli 30/56(53.6%). Recipients with TMP-SMX (n=31) had higher resistance rates to frequent used antimicrobials compared to patients without TMP-SMX (n=25), which were for amoxicillin, 69% versus 33% and for TMP-SMX 89% versus 35%. Recipients who experienced a severe UTI had a higher median serum creatinine [ 146 (107-206) μmol/L versus 122 (97-152) μmol/L, p=0.003 ] and lower median eGFR MDRD [ 44 (26-67) ml/min/1.73m² versus 51 (42-63) ml/min/1.73m², p=0.006 ] 1 year after transplantation in comparison to those who did not experienced it. However multivariable analysis indicated that severe UTI non-significantly contributed to impaired renal allograft function
CONCLUSION: The presence of indwelling urological catheter is the greatest risk factor for severe UTIs and TMP-SMX intended as PJP prophylaxis does not reduce its incidence. However it facilitates the development of amoxicillin and TMP-SMX resistance.