Comparison of the Effect of Co-Trimoxazole versus Co-Trimoxazole and Fluoroquinolones in Urinary Tract Infection Prophylaxis in Kidney Transplant Recipients: A Systematic Review and Meta-analysis

Abstract

Urinary tract infections (UTIs) are one of the most important infectious complications in kidney transplant recipients; hence, antibiotic prophylaxis is warranted. Due to limited information for selection of an appropriate antibiotic for prophylaxis, as well as the varying reports concerning increasing resistance of Escherichia coli as the common related pathogen, this systematic review and meta-analysis assess the effect of a combined regimen including fluoroquinolone + co-trimoxazole as prophylaxis in high-risk group patients. PubMed, Cochrane Library, Embase, and Web of Science were used as electronic databases to perform a systematic literature between 2010 and December 2024. A commercially available software program (EndNote X9) was used for electronic title management. Searches were performed with keywords, ("Urinary Tract Infections" OR "urinary tract infection" OR "UTI") AND ("Kidney Transplantation" OR "renal transplant*" OR "kidney transplant*") AND ("Co-Trimoxazole" OR "co-trimoxazole" OR "trimethoprim sulfamethoxazole" OR "TMP-SMX") AND ("Fluoroquinolones" OR "fluoroquinolone*" OR "ciprofloxacin" OR "levofloxacin"). A total of 454 potentially relevant titles and abstracts were found during the electronic and manual search, finally two studies were included. Heterogeneity showed a higher percentage of patients in Group I suffered from urinary infection, compared to Group II. Addition of ciprofloxacin to the standard regimen, co-trimoxazole, was related to a reduced risk of UTI in kidney transplant recipients.