Lower risk of urinary tract infection with low‐dose trimethoprim/sulfamethoxazole compared to dapsone prophylaxis in older renal transplant patients on a rapid steroid‐withdrawal immunosuppression regimen

Abstract

Background Urinary tract infections (UTI) are common in renal transplant recipients. Trimethoprim/Sulfamethoxazole (TMP/SMZ) in moderate to high daily doses prevents Pneumocystis jiroveci (PCP) and reduces the risk of UTI in renal transplant patients. Low dose TMP/SMZ also reduces the risk of PCP, though its ability to reduce the risk of UTI is uncertain. Design Retrospective review of 158 patients who received a renal transplant without corticosteroids for maintenance immunosuppression. Results Forty percent of patients initially prescribed TMP/SMZ ultimately stopped this medication early due to an adverse reaction. Urinary infection occurred in 16%, without a significant difference in the risk of UTI between those treated with dapsone versus those treated with TMP/SMZ (HR[95%CI]: 1.7 [0.75, 3.9], p=0.2). In the subset of patients who were older than age 47 years, (mean age for this cohort, SD +/−6.2 years) those treated with dapsone originally or who switched from TMP/SMZ to dapsone had a greater risk of UTI compared to patients who remained on TMP/SMZ (HR[95%CI]: 4.3 [1.2, 15.5], p=0.024). Conclusions For renal transplant recipients over the age of 47 years, treated without long-term glucocorticoids, our retrospective data suggest low dose TMP/SMZ is associated with a lower risk of UTI compared to dapsone prophylaxis.

Dapsone‐Associated Methemoglobinemia in a Patient With Slow NAT2*5B Haplotype and Impaired Cytochrome b5 Reductase Activity

“…1 However, dapsone can lead to dose-dependent hematologic toxicity and is the most commonly recognized cause of acquired methemoglobinemia in human patients. 2 The hydroxylamine metabolite of dapsone oxidizes the iron moiety of hemoglobin, 3 which leads to increased levels of methemoglobin, impaired oxygen delivery, and cyanosis.…”

Does early removal of Foley’s catheter have any influence on infection of recipient post renal transplantation? Is it safe? A randomized clinical trial

“…UTI in the first month of post-transplantation is a pivotal risk factor for inducing septicemia and mortality in kidney recipients (22)(23)(24). Anti-rejection medicines, urethral catheter and intravascular catheter increase the risk of infection in kidney transplant of recipients (25). Using prophylaxis as a preventive treatment for UTI, it occurs in first months in high incidence in kidney recipients (20).…”

Investigation of the effectiveness of antibacterial prophylaxis in renal transplant recipients

“…RTRs have multiple risk factors for acquiring UTIs post-renal transplant. A front runner is immunosuppressive therapy, which can lead to a higher incidence of infection [13][14][15] and different infection epidemiology [16]. It has also been shown that catheterization for longer than two days is an important risk factor [17].…”