Benefits of sulfamethoxazole‐trimethoprim prophylaxis on rates of sepsis after kidney transplant. Issue 2 (13th March 2014)

• Record Type: Journal Article
• Authors: Horwedel, T.A.; Bowman, L.J.; Saab, G.; Brennan, D.C.
• Is Part Of: Transplant infectious disease. Volume 16:Issue 2(2014)
• Page Start: 261
• Page End: 269
• Publication Date: 2014-03-13
• Subjects: Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12196
• Languages: English
• ISSNs: 1398-2273

Abstract

<abstract abstract-type="main" id="tid12196-abs-0001"> <title>Abstract</title> <sec id="tid12196-sec-0001" sec-type="section"> <title>Background</title> <p>The use of potent immunosuppression increases the risk of infectious complications following kidney transplantation. Sulfamethoxazole‐trimethoprim (SMX/TMP) is an inexpensive broad‐spectrum antimicrobial agent used in our center as lifelong prophylaxis against <italic>Pneumocystis jirovecii</italic>, unless contraindicated. This study evaluated the clinical impact of SMX/TMP prophylaxis compared with no prophylaxis with SMX/TMP (NoPPx), but with alternative agents.</p> </sec> <sec id="tid12196-sec-0002" sec-type="section"> <title>Methods</title> <p>This was a retrospective cohort analysis of renal transplant recipients (RTR) transplanted from January 2002 through December 2010. Patients were divided into SMX/TMP group and NoPPX group, based on whether they received prophylaxis with SMX/TMP or not, and rates of sepsis were compared between groups. We also analyzed the pathogens and source implicated in these episodes, as well as the dose of SMX/TMP. Rates were compared using multivariate logistic regression.</p> </sec> <sec id="tid12196-sec-0003" sec-type="section"> <title>Results</title> <p>With a mean follow‐up of 4.8 (± 2.5) years, 63 cases of sepsis occurred in 1224 patients (5.1%), and 60% of these cases had a urinary source. The risk of sepsis was significantly reduced with prophylaxis vs. NoPPx (13.3% vs. 4.3% for SMX/TMP, <italic> P</italic> < 0.001), and this association was maintained through multivariate regression. Sepsis was associated with a numerically increased risk of graft loss and death that was not significantly affected by use of SMX/TMP.</p> </sec> <sec id="tid12196-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Prophylaxis with SMX/TMP is an inexpensive way to reduce the incidence of sepsis in RTR.</p> </sec> </abstract>