Cipro is not better for prophylaxis of UI after transplantation with stent

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

The use of ciprofloxacin, a fluoroquinolone antibiotic, as an alternative for prophylaxis did not significantly reduce the incidence of UI compared to the 19.4% of historic incidence of UTI using SMX-TMP 480 mg, Payal P. Kakadiya, PharmD and colleagues at Virginia Commonwealth University Health In Richmond, Virginia, reported.

The researchers found a similar rate of UTI of 17% with ciprofloxacin in a poster review of 182 recipients with a graft that received ciprofloxacin for prophylaxis of the ureteral stent in 2014. UTI was diagnosed as positive urinalysis and culture within one year of transplantation .

In addition, the investigators tested the susceptibility to fluoroquinolone 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 UI prophylaxis in renal transplant patients with ureteral stents due to similar rates of UTIs and high rates of fluoroquinolone-resistant infections,” said researcher Spencer LeCorchick, PharmD, BCPS at Renal & Urology News. Name of the team. “Continued use of SMX-TMP is warranted due to similar ICU rates and additional prophylactic coverage of PCPs offered. Other measures such as early extirpation of Foley catheters and stents may 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 patients with renal transplantation with ureteral stents. SMX-TMP is often selected for prophylaxis because it covers both Pneumocystis jiroveci pneumonia and UTI.

 

The following article is part of the cover of the conference of the American Congress of Transplants (ATC) of 2017 in Chicago, Illinois. Renal and Urology News staff will report on the latest news related to research conducted by leading transplant experts. See the latest ATC 2017 news.