#5808 EFFECTIVENESS OF ORAL FOSFOMYCIN PROPHYLAXIS IN KIDNEY TRANSPLANT RECIPIENTS

Abstract

Abstract Background and Aims Urinary tract infections (UTIs) are one of the most common infectious complications in kidney transplant recipients (KTR), which are of great importance due to their high morbidity and recurrent nature. Our main objective was to evaluate the effectiveness of oral fosfomycin prophylaxis in a group of high-risk patients with recurrent/relapsing urinary tract infections. Method Retrospective study of a cohort of 60 KTR with frequent UTIs who had been prescribed daily fosfomycin calcium or fosfomycin trometamol every 7-10 days for prophylactic purposes. Demographic, clinical, analytical and microbiological data were collected during a year before and after prophylaxis. Results The median age was 61.8 (55.6-71.2) years, 68.3% were men, with 7.4 (2.8-13.6) years since the transplant. The main etiologies of the underlying renal disease were: autosomal dominant polycystic kidney disease 20%, chronic glomerulonephritis 18.3%, chronic tubulointerstitial nephropathy 10%, and diabetic kidney disease 10%, In 51.7% there was chronic pathology of the urinary tract (mainly vesico-prostatic disease, 24.8% and vesico-ureteral reflux, 15%), with a history of urological surgery in 23.3%. Up to 20% of the KTR had some type of endourological device (permanent/intermittent bladder catheter, percutaneous nephrostomy, Bricker, etc). The most frequently isolated germs were: E. coli and K. pneumoniae, 35.2 and 13.6% pre-prophylaxis and 28.3 and 22.6%, post-prophylaxis, respectively. The median number of UTI pre vs post-prophylaxis was 2 (1-4.75) vs. 1 (0.5-1.6) episode/patient/year (p<0.001), with a reduction in UTI episodes in 69% of patients. Admissions were also reduced, going from 35% in the pre-prophylaxis year to 10% post (p = 0.001). After prophylaxis, the percentage of resistance to fosfomycin increased from 26 to 54%. and a greater number of multi-resistant germs were isolated, 17.7 pre- vs 35% post-. The renal function remained stable during follow-up [CKD-EPI pre- 47.2(20.8) vs 47.2(21.2) ml/min post-]. Conclusion Oral fosfomycin prophylaxis may be useful in KTR despite the underlying urological pathology, managing to reduce UTI episodes and the need for admission for this reason.