Impact of increased duration of trimethoprim-sulfamethoxazole prophylaxis for pneumocystis pneumonia after renal transplant

Chapman, F. A., Dickerson, J. E., Daly, C., Clancy, M. and Geddes, C. (2019) Impact of increased duration of trimethoprim-sulfamethoxazole prophylaxis for pneumocystis pneumonia after renal transplant. Annals of Transplantation, 24, pp. 625-630. (doi: 10.12659/AOT.918195) (PMID:31806862) (PMCID:PMC6918803)

Abstract

Background: Trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as prophylaxis against Pneumocystis pneumonia (PCP) in renal transplant recipients. The optimal duration of prophylaxis is unknown. Longer duration of prophylaxis may increase the risk of adverse effects. The aim of this retrospective observational cohort study was to assess the impact of increasing duration of TMP-SMX prophylaxis from 3 to 6 months after transplant on drug-resistant urinary tract infection (UTI), hyperkalemia, peripheral blood cytopenias, and incidence of PCP. Material and methods: Patients transplanted over a 4.5-year period before and after a change in protocol from 3- to 6-months TMP-SMX prophylaxis in our unit were grouped according to planned duration of prophylaxis, and results were analyzed on an intention-to-treat basis. Baseline characteristics, laboratory values, and all urine microbiology results in the 6 months after transplant were analyzed. Results: The overall UTI incidence rate was higher in the 3-month (3-m) treatment group than the 6-month (6-m) treatment group (0.52 vs. 0.33 UTI per 100 patient days; rate ratio 1.56 [95% CI 1.27-1.95]). However, this was not attributable to TMP-SMX: the incidences were significantly different in months 0-3 but not months 4-6. Twenty-eight multi-resistant UTIs occurred in the 3-m group, but there were none in the 6-m group (p=0.004). There were no significant differences in renal function, serum potassium, or cytopenias during the first 6 months. There were 15 cases of PCP in the 3-m group, 3 cases in the 6-m group, and no cases during prophylaxis. Conclusions: Extending the duration of TMP-SMX prophylaxis was not associated with change in frequency of UTIs or multi-drug-resistant UTIs, nor was it associated with increased adverse events. TMP-SMX is an effective PCP prophylaxis, and these data support recommendations to extend the duration of prophylaxis after transplant.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Geddes, Dr Colin and Dickerson, Dr Jonathan and Clancy, Mr Marc
• Authors: Chapman, F. A., Dickerson, J. E., Daly, C., Clancy, M., and Geddes, C.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Transplantation
• Publisher: International Scientific Infromation, Inc.
• ISSN: 1425-9524
• ISSN (Online): 2329-0358
• Copyright Holders: Copyright © 2019 Annals of Transplantation
• First Published: First published in Annals of Transplantation 24:625-630
• Publisher Policy: Reproduced under a Creative Commons License