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Fewer kidney recipients treated with a combination of cephalexin plus sulfamethoxazole-trimethoprim (SMX-TMP) for prophylaxis against Pneumocystis pneumonia (PCP) experienced post-transplant urinary tract infection (UTI) than recipients who received cephalexin alone, researchers reported at the American Transplant Congress 2017 in Chicago.
“There was a significant decrease in UTI rates among patients treated with cephalexin in addition to SMX/TMP PCP prophylaxis compared to patients treated with SMX/TMP alone,” Patrick M. Klem, PharmD, BCPS, of the University of Colorado in Aurora, Colorado, and colleagues concluded in their study abstract. “However this benefit was lost when an alternative PCP prophylactic was used.”
Dr Klem and colleagues investigated the efficacy of cephalexin, a cephalosporin antibiotic, by comparing patient outcomes from 2 different treatment eras: 151 patients treated with cephalexin for 1 month with or without SMX-TMP during 2014 to 2015 (new era) and 661 patients treated with or without SMX-TMP alone during 2005 to 2012 (old era).
A low-dose fluoroquinolone was used in place of cephalexin in patients allergic to a cephalosporin.
In the new era, 12 patients received another fluoroquinolone, including 8 who also received SMX/TMP. UTI was identified by a positive urine culture containing more than 104 colony-forming units per mL of dilution and positive urinalysis.
In the new era, the UTI incidence rate was significantly lower in cephalexin-treated patients receiving SMX/TMP compared with those who did not receive SMX/TMP (7.5% vs 25.8%). New era SMX/TMP patients also had a significantly lower incidence rate of UTI than SMX/TMP patients in the old era (7.5% vs 16.3%). The first UTI occurred significantly later in the new era at 34 days post-transplant compared with 14 days in the old era. During both eras, the most prevalent bacteria associated with UTIs were enterococcus species and Escherichia coli.
The benefit of add-on cephalexin diminished when a prophylactic other than SMX/TMP was used, the investigators reported.
Klem P, Gralla J, Chang D, Wiseman A, Davis S,J, Cooper J. Antibiotic Prophylaxis Against Urinary Tract Infections After Renal Transplant. [abstract] Am J Transplant 2017:17 (suppl 3). Presented at the 2017 American Transplant Congress in Chicago, April 29–May 3, 2017. Abstract A186.