title: Benefits of sulfamethoxazole-trimethoprim prophylaxis on rates of sepsis after kidney transplant.
abstract: BACKGROUND
  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 Pneumocystis jirovecii, unless contraindicated. This study evaluated the clinical impact of SMX/TMP prophylaxis compared with no prophylaxis with SMX/TMP (NoPPx), but with alternative agents.
  
  
  METHODS
  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.
  
  
  RESULTS
  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, P < 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.
  
  
  CONCLUSIONS
  Prophylaxis with SMX/TMP is an inexpensive way to reduce the incidence of sepsis in RTR.
authors.affiliation: Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, Missouri, USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Horwedel
authors.forename: L J
authors.initials: LJ
authors.lastname: Bowman
authors.forename: G
authors.initials: G
authors.lastname: Saab
authors.forename: D C
authors.initials: DC
authors.lastname: Brennan
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D014552:Urinary Tract Infections / Q000150:complications
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: PCP; kidney transplant; prophylaxis; sepsis; sulfamethoxazole-trimethoprim