Perioperative fosfomycin disodium prophylaxis against urinary tract infection in renal transplant recipients: a randomized clinical trial

Rodrigo Rosado-Canto, Idalia Parra-Avila, Javier Tejeda-Maldonado, Cristopher Kauffman-Ortega, Francisco T Rodriguez-Covarrubias, Mariedel Trujeque-Matos, Rodrigo Cruz-Martínez, Ernesto Maravilla-Franco, Elia Criollo-Mora, José M Arreola-Guerra, Luis E Morales-Buenrostro, José Sifuentes-Osornio, Rodrigo Rosado-Canto, Idalia Parra-Avila, Javier Tejeda-Maldonado, Cristopher Kauffman-Ortega, Francisco T Rodriguez-Covarrubias, Mariedel Trujeque-Matos, Rodrigo Cruz-Martínez, Ernesto Maravilla-Franco, Elia Criollo-Mora, José M Arreola-Guerra, Luis E Morales-Buenrostro, José Sifuentes-Osornio

Abstract

Background: Symptomatic urinary tract infection (UTI) is the most common infectious complication in renal transplant recipients (RTRs). Fosfomycin (FOS) is an attractive alternative for prophylaxis because it does not interact with immunosuppressants; although 90% is excreted unchanged in the urine, it does not require adjustment for renal function for single dose prophylaxis.

Methods: RTRs were recruited into this randomized, double-blind, placebo-controlled trial. Participants were randomized (1:1) to receive one 4 g dose of FOS disodium intravenously 3 h (FOS group) or placebo (placebo group) before placement and removal of a urinary catheter and before removal of a double-J ureteral stent. All participants received prophylaxis with trimethoprim/sulfamethoxazole. The main outcome was a comparison of the mean number of symptomatic UTI and asymptomatic bacteriuria (AB) episodes per patient during a 7-week follow-up period. The study was registered at ClinicalTrials.gov, NTC03235947.

Results: Eighty-two participants were included (41 in the FOS group and 41 in placebo group). The mean number of AB or symptomatic UTI episodes per patient was lower in the FOS group [intention-to-treat (ITT) 0.29 versus 0.60, P = 0.04]. The incidence of symptomatic UTI was lower in the FOS group (ITT, 7.3% versus 36.6%, P = 0.001), and there was no difference in the incidence of AB between both groups. The incidence of adverse events was similar in both groups.

Conclusions: FOS addition is an effective and safe strategy to reduce the number of symptomatic UTIs during the first 7 weeks after renal transplant.

Trial registration: ClinicalTrials.gov NCT03235947.

Keywords: fosfomycin; kidney transplantation; prophylaxis; urinary tract infection.

© The Author(s) 2019. Published by Oxford University Press on behalf of ERA-EDTA.

Figures

FIGURE 1
FIGURE 1
Patient flow diagram.
FIGURE 2
FIGURE 2
Number of episodes of AB or symptomatic UTI by intervention group, FOS versus placebo. (a) ITT analysis and (b) PP analysis.
FIGURE 3
FIGURE 3
Percentage of participants free of AB or symptomatic UTI by intervention group, FOS versus placebo. (a) ITT analysis and (b) PP analysis.
FIGURE 4
FIGURE 4
Percentage of participants free of symptomatic UTI by intervention group, FOS versus placebo. (a) ITT analysis and (b) PP analysis.
FIGURE 5
FIGURE 5
Percentage of participants free of AB by intervention group, FOS versus placebo. (a) ITT analysis and (b) PP analysis.

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Source: PubMed

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