Cipro Not Better for UTI Prophylaxis After Transplant With Stent

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In a study of renal transplant patients who received ureteral stents, ciprofloxacin did not lower the incidence of UTI compared with SMX-TMP.
In a study of renal transplant patients who received ureteral stents, ciprofloxacin did not lower the incidence of UTI compared with SMX-TMP.
The following article is part of conference coverage from the 2017 American Transplant Congress (ATC) in Chicago, Illinois. Renal and Urology News' staff will be reporting breaking news associated with research conducted by leading experts in transplantation. Check back for the latest news from ATC 2017. 

Clinicians need not abandon sulfamethoxazole-trimethoprim (SMX-TMP) in favor of ciprofloxacin for urinary tract infection (UTI) prophylaxis in renal transplant patients with ureteral stents, according to the latest research presented at the 2017 American Transplant Congress in Chicago.

Using ciprofloxacin, a fluoroquinolone antibiotic, as an alternative for prophylaxis did not significantly lower the incidence of UTI compared with the 19.4% historical incidence of UTI using SMX-TMP 480 mg, Payal P. Kakadiya, PharmD, and colleagues of Virginia Commonwealth University Health in Richmond, Virginia, reported.

The investigators found a similarly high UTI rate of 17% with ciprofloxacin in a chart review of 182 recipients with a functioning graft who received ciprofloxacin for ureteral stent prophylaxis in 2014. UTI was diagnosed as positive urinalysis and culture within a year of transplant.

In addition, the researchers tested for fluoroquinolone susceptibility and found that approximately 35% of susceptible organisms were resistant. The most common pathogen causing UTIs was Escherichia coli.

“These data do not support the use of ciprofloxacin for UTI prophylaxis in renal transplant patients with ureteral stents due to similar rates of UTI and high rates of fluoroquinolone resistant infections,” investigator Spencer LeCorchick, PharmD, BCPS, told Renal & Urology News, on behalf of the team. “Continued used of SMX-TMP is justified due to similar UTI rates and the additional PCP prophylactic coverage offered. Other measures like early removal of Foley catheters and stents might be more important than antibiotic prophylaxis."

While ureteral stents decrease the risk of ureteral complications, they increase the risk of UTI. Current guidelines do not recommend antibiotic prophylaxis in renal transplant patients with ureteral stents. SMX-TMP is often selected for prophylaxis because it covers both Pneumocystis jiroveci pneumonia and UTI.

Visit Renal and Urology News' conference section for continuous coverage from ATC 2017. 

Reference

Kakadiya P, Levy M, Gupta G, King A, and LeCorchick S. Ciprofloxacin for urinary tract infection prophylaxis in post-renal transplant patients with ureteral stent placement. Presented at the American Transplant Congress in Chicago, April 29-May 3, 2017. Abstract A203.

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