title: The impact of trimethoprim-sulfamethoxazole as Pneumocystis jiroveci pneumonia prophylaxis on the occurrence of asymptomatic bacteriuria and urinary tract infections among renal allograft recipients: a retrospective before-after study.
abstract: BACKGROUND
  The international guidelines recommend the administration of trimethoprim-sulfamethoxazole (TMP-SMX) as Pneumocystis jiroveci pneumonia (PJP) prophylaxis for six months after transplantation. The aim of this study is to evaluate the influence of TMP-SMX prophylaxis on the occurrence of asymptomatic bacteriuria (ASB) and urinary tract infections (UTIs) as cystitis and allograft pyelonephritis (AGPN) and its impact on the antimicrobial resistance pattern of causative microorganisms.
  
  
  METHODS
  We have conducted a retrospective before-after study in adult renal allograft recipients with one year follow-up after transplantation. We compared the ("after") group that received TMP-SMX as PJP prophylaxis to the ("before") group that did not receive it.
  
  
  RESULTS
  In total, 343 renal allograft recipients were analysed, of whom 212 (61.8 %) received TMP-SMX as PJP prophylaxis. In this study, 63 (18.4 %) did only develop ASB without UTI, 26 (7.6 %) developed cystitis and 43 (12.5 %) developed AGPN. The remaining 211 (61.5 %) renal allograft recipients did not develop any bacteriuria at all. Multivariable Cox proportional regression analysis indicated that TMP-SMX as PJP prophylaxis was not associated with reduced prevalence of ASB (Hazard ratio (HR) = 1.52, 95 % CI = 0.79-2.94, p = 0.213), nor with reduced incidence of cystitis (HR = 2.21, 95 % CI = 0.76-6.39, p = 0.144), nor AGPN (HR = 1.12, 95 % CI = 0.57-2.21, p = 0.751). Among the group receiving TMP-SMX as PJP prophylaxis there was a trend was observed in increase of both amoxicillin (86 % versus 70 %) and TMP-SMX (89 % versus 48 %) resistance which already appeared within the first 30 days after TMP-SMX exposure.
  
  
  CONCLUSIONS
  Among renal allograft recipients, administration of TMP-SMX as PJP prophylaxis does not prevent ASB nor UTI, however it is associated with tendency towards increased amoxicillin and TMP-SMX resistance.
authors.affiliation: Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands. r.singh@amc.uva.nl.
authors.forename: Ramandeep
authors.initials: R
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands. f.j.bemelman@amc.uva.nl.
authors.forename: Frederike J
authors.initials: FJ
authors.lastname: Bemelman
authors.affiliation: Department of Medical Microbiology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands. c.j.hodiamont@amc.uva.nl.
authors.forename: Caspar J
authors.initials: CJ
authors.lastname: Hodiamont
authors.affiliation: Department of Surgery, Division of Vascular Surgery, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands. m.m.idu@amc.uva.nl.
authors.forename: Mirza M
authors.initials: MM
authors.lastname: Idu
authors.affiliation: Department of Internal Medicine, Renal transplant Unit, Division of Nephrology, Academic Medical Center - University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands. r.j.tenberge@amc.uva.nl.
authors.forename: Ineke J M
authors.initials: IJ
authors.lastname: Ten Berge
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center-University of Amsterdam, PO box 22660, 1100 DD, Amsterdam, The Netherlands. s.e.geerlings@amc.uva.nl.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Geerlings
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D058070:Asymptomatic Diseases; D001437:Bacteriuria / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D065187:Controlled Before-After Studies; D003556:Cystitis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D045363:Pneumocystis carinii; D011020:Pneumonia, Pneumocystis / Q000209:etiology / Q000517:prevention & control*; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D011704:Pyelonephritis / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination