Asymptomatic bacteriuria in kidney transplant recipients: to treat or not to treat—that is the question

Sabé, Núria; Cruzado, Josep M.; Carratalà, Jordi

doi:10.1016/j.cmi.2020.11.016

Cited by 3 publications

(6 citation statements)

References 12 publications

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“…A study recently conducted in France and Belgium among kidney transplant recipients with asymptomatic bacteriuria at least 2 months after transplantation demonstrated no significant difference in the incidence of symptomatic urinary tract infection over the subsequent 12 months in patients randomly allocated to either antibiotic therapy or no antibiotic therapy 44 . This study reinforced the findings of prior studies and supports guideline recommendations against systematic screening and treatment of asymptomatic bacteriuria in kidney transplant recipients 43,45,46 Cytomegalovirus (CMV) prophylaxis : CMV continues to be a problematic opportunistic pathogen for many SOT patient populations which necessitates careful monitoring and adjustment of antiviral therapy.…”

Section: Peri‐operative Antimicrobial Stewardshipsupporting

confidence: 66%

“… Urinary tract infections : overtreatment of asymptomatic bacteriuria continues to be a prominent problem among immunocompetent and immunocompromised patients with significant potential to increase patient exposure to antibiotics and help drive antimicrobial resistance. 43 A study recently conducted in France and Belgium among kidney transplant recipients with asymptomatic bacteriuria at least 2 months after transplantation demonstrated no significant difference in the incidence of symptomatic urinary tract infection over the subsequent 12 months in patients randomly allocated to either antibiotic therapy or no antibiotic therapy. 44 This study reinforced the findings of prior studies and supports guideline recommendations against systematic screening and treatment of asymptomatic bacteriuria in kidney transplant recipients.…”

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

“… 44 This study reinforced the findings of prior studies and supports guideline recommendations against systematic screening and treatment of asymptomatic bacteriuria in kidney transplant recipients. 43 , 45 , 46 Cytomegalovirus (CMV) prophylaxis : CMV continues to be a problematic opportunistic pathogen for many SOT patient populations which necessitates careful monitoring and adjustment of antiviral therapy. Focused interventions involving multidisciplinary teams have been demonstrated to be effective in optimizing these antiviral therapy regimens in the ambulatory setting.…”

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

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Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation

Kinn

İnce

2022

Transplant Infectious Dis

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Background:The consequences of inappropriate antimicrobial use including resistance are increasingly recognized as a global public health threat and many steps have been taken over the last few decades to advance antimicrobial stewardship initiatives with most organ transplant centers currently part of institutions with active antimicrobial stewardship programs.Methods: A review of the literature was conducted and articles were categorized according to the topic and relevance in the judgment of the two authors.Results: A summary review of the currently available literature was created with a focus on periprocedural and outpatient antimicrobial stewardship. Limitations in the data were significant and discussed in the review. Conclusion:The principles of antimicrobial stewardship remain important throughout all phases starting with periprocedural prophylactic antimicrobial selection all the way through to discharge and subsequent healthcare encounters. Despite the broad advances in stewardship initiatives and the rapidly progressing supportive data overall there continue to be significant opportunities for additional research within various special patient populations including recipients of solid organ transplantation (SOT).The recent white paper published in the American Journal of Transplantation called to action the transplant and stewardship communities to have an increased focus and awareness of the issues that antimicrobial overuse can present in the SOT patient population. This is an important step that will hopefully generate more data in this group of patients that arguably faces the greatest vulnerability to the consequences of increased antimicrobial resistance.

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Section: Peri‐operative Antimicrobial Stewardshipsupporting

confidence: 66%

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

Section: Peri‐operative Antimicrobial Stewardshipmentioning

confidence: 99%

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Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation

Kinn

İnce

2022

Transplant Infectious Dis

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“…New measures are needed to improve the management of AGP after KT. Importantly, the potential preventive role of antibiotic treatment for asymptomatic bacteriuria has been questioned in randomized trials and, in fact, there is little evidence to support its use [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors and Outcomes of Acute Graft Pyelonephritis with Bacteremia Due to Multidrug-Resistant Gram-Negative Bacilli among Kidney Transplant Recipients

Sabé

Maristany

Tuells

et al. 2022

JCM

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Acute graft pyelonephritis (AGP) is the leading cause of bloodstream infection in kidney transplant (KT) recipients. The prevalence of urinary tract infections caused by multidrug-resistant (MDR) Gram-negative bacilli is increasing. This 14-year prospective observational study sought to determine the clinical characteristics, risk factors, and outcomes of AGP with bacteremia due to MDR Gram-negative bacilli. Overall, 278 episodes of AGP with bacteremia due to MDR Gram-negative and non-MDR Gram-negative bacilli were identified and compared in 214 KT recipients; MDR Gram-negative bacilli were the cause in 28.4%. Overall 30-day mortality was low (1.1%). Risk factors independently associated with AGP due to MDR Gram-negative bacilli were male sex (OR 3.08; 95%CI 1.60–5.93), previous episode of bacteremic AGP (OR 2.11, 95%CI 1.09–4.09), prior antibiotic therapy in the preceding month (OR 2.47, 95%CI 1.33–4.57), and nosocomial acquisition (OR 2.03, 95%CI 1.14–3.62). Forty-three percent of MDR Gram-negative episodes received inappropriate empirical antibiotic therapy. The risk factors identified in this study may help physicians when selecting empirical antibiotic treatment for AGP. Previous antibiotic use was the main modifiable factor. Its presence highlights the importance of avoiding unnecessary antibiotics in order to bring down the high rates of MDR Gram-negative bacilli infections in this population.

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Opportunities for Antimicrobial Stewardship Interventions Among Solid Organ Transplant Recipients

Stohs

Gorsline

2023

Infectious Disease Clinics of North America

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Asymptomatic bacteriuria in kidney transplant recipients: to treat or not to treat—that is the question

Cited by 3 publications

References 12 publications

Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation

Outpatient and peri‐operative antibiotic stewardship in solid organ transplantation

Risk Factors and Outcomes of Acute Graft Pyelonephritis with Bacteremia Due to Multidrug-Resistant Gram-Negative Bacilli among Kidney Transplant Recipients

Opportunities for Antimicrobial Stewardship Interventions Among Solid Organ Transplant Recipients

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