title: Ofloxacin: new applications for the prevention of urinary tract infections in renal graft recipients.
abstract: BACKGROUND
  Urinary tract infections (UTIs), the most common form of bacterial infection in kidney transplant recipients, recently have been demonstrated to be detrimental for long-term graft outcome. Therefore, reinforcing antibiotic prophylaxis might be vital, in addition to basic hygiene recommendations, surgical care, and prophylaxis by trimethoprim-sulfamethoxazole.
  
  
  METHODS
  In 2006, a Legionella pneumophila contamination of our department's water pipes meant that all the patients undergoing renal transplantation underwent a 1-month regimen of ofloxacin (OFLO) (200 mg every other day). We took this opportunity to measure the incidence of UTI, including acute pyelonephritis (APN), in 100 consecutive patients transplanted before (n = 50) and after (n = 50) this treatment decision was reached. We also studied the antimicrobial resistance profiles in our department and in the rest of the hospital.
  
  
  RESULTS
  No patient developed Legionnaire's disease. A dramatic decrease in the incidence of UTI (-63%) was also seen in patients undergoing OFLO treatment. Logistic regression analysis demonstrated that the use of OFLO was independently associated with a reduction in UTI (odd ratio [OR] = 0.31%, 95% confidence interval [CI] 0.11-0.84, P = 0.02) and APN (OR = 0.21%, 95% CI 0.07-0.98, P = 0.045). This protection was sustained during the whole first year post transplantation. As for resistance rates, we observed a decrease in the susceptibility of Pseudomonas aeruginosa to ciprofloxacin in our nephrology department, compared with that observed in the rest of the hospital. The incidence of multi-resistant bacteria was stable.
  
  
  CONCLUSIONS
  Our unintentional extension of prophylactic antibiotherapy with OFLO gave rise to a dramatic decrease in the 1-year incidence of UTI and APN in kidney recipients. Emergence of resistant strains is, however, a major concern.
authors.affiliation: Urgences Néphrologiques et Transplantation Rénale, APHP, Hôpital Tenon, Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Rafat
authors.forename: S
authors.initials: S
authors.lastname: Vimont
authors.forename: P Y
authors.initials: PY
authors.lastname: Ancel
authors.forename: Y C
authors.initials: YC
authors.lastname: Xu-Dubois
authors.forename: L
authors.initials: L
authors.lastname: Mesnard
authors.forename: N
authors.initials: N
authors.lastname: Ouali
authors.forename: M
authors.initials: M
authors.lastname: Denis
authors.forename: A
authors.initials: A
authors.lastname: Vandewalle
authors.forename: E
authors.initials: E
authors.lastname: Rondeau
authors.forename: A
authors.initials: A
authors.lastname: Hertig
mesh_terms: D000208:Acute Disease; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology / Q000627:therapeutic use; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D016952:Legionella pneumophila / Q000187:drug effects; D007877:Legionnaires' Disease / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000494:pharmacology / Q000627:therapeutic use*; D011704:Pyelonephritis / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D015242:Ofloxacin