title: Effect of ciprofloxacin combined with sulfamethoxazole-trimethoprim prophylaxis on the incidence of urinary tract infections after kidney transplantation.
abstract: BACKGROUND
  Urinary tract infections (UTIs) are common after kidney transplantation, with limited data to guide antibiotic prophylaxis.
  
  
  METHODS
  Retrospective single-center study comparing sulfamethoxazole-trimethoprim 800/160 mg (SMZ/TMP) daily for 30 days followed by Monday, Wednesday, Friday for an additional 5 months (Group 1) versus SMZ/TMP Monday, Wednesday, Friday for 6 months plus ciprofloxacin 250 mg twice daily for 30 days (Group 2) on UTI incidence after kidney transplantation.
  
  
  RESULTS
  There were 106 and 130 patients in Groups 1 and 2, respectively. Demographics and transplant characteristics were well matched, except for more patients in Group 2 on corticosteroid maintenance. At 1 year, more patients in Group 1 developed UTIs (23.6% vs. 10.8%; P=0.01) and the mean time to first UTI was shorter (96.6±79.5 vs. 168±89.7 days; P=0.01). UTIs caused by Enterococcus species were higher in Group 2 (28.6% vs. 4%; P=0.047) with enteric gram-negative bacilli accounting for the remaining infections. There was a similar incidence of enteric gram-negative antibiotic resistance to SMZ/TMP (75% vs. 80%; P=1.00) and ciprofloxacin (16.7% vs. 30%; P=0.39) in Groups 1 and 2. For Groups 1 and 2, the proportion of first UTIs requiring hospitalization was 48.9% vs. 40.6%, respectively (P=0.62). Female gender was a UTI risk factor (hazard ratio, 3.5; 95% confidence interval, 1.78-6.8; P=0.0003).
  
  
  CONCLUSIONS
  The addition of a 30-day course of ciprofloxacin lowered the incidence of UTI; randomized prospective studies are needed to confirm the safety and efficacy of this approach.
authors.affiliation: Kidney Transplant Service, Division of Nephrology, Department of Medicine, University of California-San Francisco, 400 Parnassus Avenue, San Francisco, CA 94143, USA. david.wojciechowski@ucsf.edu
authors.forename: David
authors.initials: D
authors.lastname: Wojciechowski
authors.forename: Sindhu
authors.initials: S
authors.lastname: Chandran
mesh_terms: D000328:Adult; D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage*; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D002939:Ciprofloxacin / Q000008:administration & dosage*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*
chemical_list: D000892:Anti-Infective Agents, Urinary; D002939:Ciprofloxacin; D015662:Trimethoprim, Sulfamethoxazole Drug Combination