Comparison of the effect of co-trimoxazole and co-trimoxazole plus ciprofloxacin in urinary tract infection prophylaxis in kidney transplant patients

Khorvash, Farzin; Mortazavi, Mojgan; Hakamifard, Atousa; Ataei, Behrooz

Comparison of the effect of co-trimoxazole and co-trimoxazole plus ciprofloxacin in urinary tract infection prophylaxis in kidney transplant patients

Authors

¹ Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

² Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

³ Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

⁴ Department of Infectious Diseases, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Urinary tract infection (UTI) as an important infection in the setting of renal transplantation carries the high mortality and morbidity rate. Thus, the prevention of this infection should receive higher priority. However, bacterial resistance to antibiotics is on the rise, with limited data to guide prophylaxis. The purpose of this study was to compare the effect of sulfamethoxazole-trimethoprim (SMZ/TMP) and SMZ/TMP plus ciprofloxacin for prophylaxis of UTI in renal transplant recipients.
Materials and Methods: In a clinical trial study, 50 patients were included and divided into two groups of 25 using block randomization. Patients in Group I received prophylactic SMZ/TMP and those in Group II received ciprofloxacin plus SMZ/TMP. The incidence of UTI in the two groups at 1, 3, and 6 months after transplantation was evaluated. This study was registered in Iranian Registry of Clinical Trial (IRCT number: IRCT 2015120823743N1).

Results: Of the 61 patients older than 18 years at the time of transplantation, 50 were included. UTI was documented in 8 patients (32%) in Group I and 3 (12%) in Group II (P = 0.026). The average time for the development of the first case of infection was the same for both groups (P = 0.241), and it was at its maximum in the 1^st month. Urinary infections caused by Escherichia coli, the dominant strain, were the same in both groups (P = 0.673).
Conclusions: Our study shows that the addition of 1 month course of ciprofloxacin lowered the incidence of UTI. More studies are needed to confirm the efficacy of this approach.

Keywords

References

1.	Iqbal T, Naqvi R, Akhter SF. Frequency of urinary tract infection in renal transplant recipients and effect on graft function. J Pak Med Assoc 2010;60:826-9.
2.	Schmaldienst S, Dittrich E, Hörl WH. Urinary tract infections after renal transplantation. Curr Opin Urol 2002;12:125-30.
3.	Müller V, Becker G, Delfs M, Albrecht KH, Philipp T, Heemann U. Do urinary tract infections trigger chronic kidney transplant rejection in man? J Urol 1998;159:1826-9.
4.	Säemann M, Hörl WH. Urinary tract infection in renal transplant recipients. Eur J Clin Invest 2008;38 Suppl 2:58-65.
5.	Kentouni-Noly JC, Cloix P, Martin X, Rabodonirina M, Lefrancois N, Sepetjan M. Analysis of nosocomial infections in renal transplant and pancreas transplant recipients. Transplant Proc 1994;26:284.
6.	Midtvedt K, Hartmann A, Midtvedt T, Brekke IB. Routine perioperative antibiotic prophylaxis in renal transplantation. Nephrol Dial Transplant 1998;13:1637-41. [PUBMED]
7.	Ritter J, Lewis LD, Mant TG, Ferro A. A Textbook of Clinical Pharmacology and Therapeutics. 8^th ed. London: Hodder Arnold; 2008.
8.	Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group. KDIGO clinical practice guideline for the care of kidney transplant recipients. Am J Transplant 2009;9 Suppl 3:S1-155. [PUBMED]
9.	Karuthu S, Blumberg EA. Common infections in kidney transplant recipients. Clin J Am Soc Nephrol 2012;7:2058-70.
10.	Di Cocco P, Orlando G, Mazzotta C, Rizza V, D'Angelo M, Clemente K, et al. Incidence of urinary tract infections caused by germs resistant to antibiotics commonly used after renal transplantation. Transplant Proc 2008;40:1881-4.
11.	Wojciechowski D, Chanda R, Chandran S, et al. Ciprofloxacin prophylaxis in kidney transplant recipients reduces BK virus infection at 3 months but not at 1 year. Transplantation 2012; 94:1117.
12.	Abbott KC, Swanson SJ, Richter ER, Bohen EM, Agodoa LY, Peters TG, et al. Late urinary tract infection after renal transplantation in the United States. Am J Kidney Dis 2004;44:353-62.
13.	Maraha B, Bonten H, van Hooff H, Fiolet H, Buiting AG, Stobberingh EE. Infectious complications and antibiotic use in renal transplant recipients during a 1-year follow-up. Clin Microbiol Infect 2001;7:619-25.
14.	American journal of transplantation. Urinary tract infection in solid organ transplantation. 2013; 13:327-336.
15.	Chuang P, Parikh CR, Langone A. Urinary tract infections after renal transplantation: A retrospective review at two US transplant centers. Clin Transplant 2005;19:230-5.
16.	Lyerová L, Viklický O, Nemcová D, Teplan V. The incidence of infectious diseases after renal transplantation: A single-centre experience. Int J Antimicrob Agents 2008;31 Suppl 1:S58-62.
17.	Abbott KC, Oliver JD 3^rd, Hypolite I, Lepler LL, Kirk AD, Ko CW, et al. Hospitalizations for bacterial septicemia after renal transplantation in the united states. Am J Nephrol 2001;21:120-7.
18.	Golebiewska J, Debska-Slizien A, Komarnicka J, Samet A, Rutkowski B. Urinary tract infections in renal transplant recipients. Transplant Proc 2011;43:2985-90.
19.	Esezobor CI, Nourse P, Gajjar P. Urinary tract infection following kidney transplantation: Frequency, risk factors and graft function. Pediatr Nephrol 2012;27:651-7.
20.	Kawecki D, Pacholczyk M, Lagiewska B, Adadynski L, Lisik W, Sawicka-Grzelak A, et al. Urinary tract infections in the early posttransplant period after liver transplantation: Etiologic agents and their susceptibility. Transplant Proc 2011;43:3052-4.
21.	Green H, Rahamimov R, Gafter U, Leibovitci L, Paul M. Antibiotic prophylaxis for urinary tract infections in renal transplant recipients: A systematic review and meta-analysis. Transpl Infect Dis 2011;13:441-7.
22.	Fox BC, Sollinger HW, Belzer FO, Maki DG. A prospective, randomized, double-blind study of trimethoprim-sulfamethoxazole for prophylaxis of infection in renal transplantation: Clinical efficacy, absorption of trimethoprim-sulfamethoxazole, effects on the microflora, and the cost-benefit of prophylaxis. Am J Med 1990;89:255-74.
23.	Tolkoff-Rubin NE, Cosimi AB, Russell PS, Rubin RH. A controlled study of trimethoprim-sulfamethoxazole prophylaxis of urinary tract infection in renal transplant recipients. Rev Infect Dis 1982;4:614-8. [PUBMED]
24.	Moysés Neto M, Costa RS, Reis MA, Ferraz AS, Saber LT, Batista ME, et al. Use of ciprofloxacin as a prophylactic agent in urinary tract infections in renal transplant recipients. Clin Transplant 1997;11:446-52.
25.	Kawecki D, Kwiatkowski A, Sawicka-Grzelak A, Durlik M, Paczek L, Chmura A, et al. Urinary tract infections in the early posttransplant period after kidney transplantation: Etiologic agents and their susceptibility. Transplant Proc 2011;43:2991-3.
26.	Hibberd PL, Tolkoff-Rubin NE, Doran M, Delvecchio A, Cosimi AB, Delmonico FL, et al. Trimethoprim-sulfamethoxazole compared with ciprofloxacin for the prevention of urinary tract infection in renal transplant recipients. A double-blind, randomized controlled trial. Online J Curr Clin Trials 1992; Doc No 15.
27.	Wojciechowski D, Chandran S. Effect of ciprofloxacin combined with sulfamethoxazole-trimethoprim prophylaxis on the incidence of urinary tract infections after kidney transplantation. Transplantation 2013;96:400-5.
28.	Rafat C, Vimont S, Ancel PY, Xu-Dubois YC, Mesnard L, Ouali N, et al. Ofloxacin: New applications for the prevention of urinary tract infections in renal graft recipients. Transpl Infect Dis 2011;13:344-52.

Advanced Biomedical Research