Short-Term Outcome of Untreated Versus Treated Asymptomatic Bacteriuria in Renal Transplant Patients

Arencibia, N.; Agüera, María Luisa; Rodelo, C.; López, Isabel; Sánchez-Agesta, Marina; Hurtarte, A.R.; Navarro, María Dolores; Rodríguez‐Benot, Alberto

doi:10.1016/j.transproceed.2016.07.041

Cited by 17 publications

(16 citation statements)

References 10 publications

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“…The variable time interval between the detection of the ASB and the onset of the symptoms was, at times, too short to allow targeted antibiotic treatment, and at times too long to establish a causal link. Moreover, as reported in several studies, there was a low proportion of ASB episodes that were followed by a symptomatic UTI in which the same microorganism was isolated . Similarly, even 30% of the cases of pyelonephritis were not preceded by ASB in the study of Origüen et al, limiting the possibility of preventing this complication with the systematic ASB treatment practice …”

Section: Discussionmentioning

confidence: 78%

“…Moreover, as reported in several studies, there was a low proportion of ASB episodes that were followed by a symptomatic UTI in which the same microorganism was isolated. 21,27 Similarly, even 30% of the cases of pyelonephritis were not preceded by ASB in the study of Origüen et al, limiting the possibility of preventing this complication with the systematic ASB treatment practice. 21 An essential factor to consider when analyzing the applicability of this evidence is the time after KT of included patients.…”

Section: Discussionmentioning

confidence: 94%

“…Nine studies were included in this meta‐analysis; summaries of each are found in the web‐only Table S1 . When comparing ASB treatment (n = 500) to no treatment (n = 853), the relative risk (RR) for symptomatic UTI occurrence among treated patients was not significantly lower than the risk of not treated ones (OR 1.08; 95% CI 0.63‐1.84), with a moderate heterogeneity ( I 2 35%)(Figure ). On the other hand, three studies evaluated the impact in the graft function, described as the difference in the creatinine serum levels at the beginning and the end of the study.…”

Section: Resultsmentioning

confidence: 99%

“…Nine studies were included in this meta-analysis; summaries of each are found in the web-only Table S1. 18,19,21,23,28 When comparing ASB treatment (n = 500) to no treatment (n = 853), the relative risk (RR) for symptomatic UTI occurrence among treated patients was not significantly lower than the risk of not treated ones (OR 1.08; 95% CI 0.63-1.84), with a moderate heterogeneity (I 2 35%) 18,19,21,[23][24][25][26][27] (Figure 3).…”

Section: Risk Of Symptomatic Uti and Impact In Graft Functionmentioning

confidence: 99%

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Systematic review and meta‐analysis of asymptomatic bacteriuria after renal transplantation: incidence, risk of complications, and treatment outcomes

Gómez‐Ochoa

Vega-Vera

2019

Transplant Infectious Dis

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Background Routine treatment for asymptomatic bacteriuria (ASB) after renal transplantation (RT) represents nowadays a controversial topic, being unknown its impact on the overall prognosis of the transplanted patient. Methods Studies published during 1970‐2019 that evaluated the benefit of treating ASB after RT regarding the risk of renal complications were included. The primary outcome was to assess whether the treatment is associated with a lower risk of symptomatic urinary tract infection (UTI) or an improved renal function at the end of the follow‐up period. The secondary outcome was the risk of acute graft rejection (AGR). A meta‐analysis with a random‐effect model was performed. Heterogeneity was assessed with the I2 measure. Results Fifteen studies were included. The incidence of ASB in the first month and the first year after RT was 22% and 30%, respectively. ASB was not correlated to AGR (OR 1.18; 95% CI, 0.78‐1.79). Eight studies compared the outcomes of ASB treatment, finding no benefit of treating regarding the risk of symptomatic UTI (OR 1.08; 95% CI, 0.63‐1.84; I2 = 35%) or the change in renal function (mean difference in serum creatinine concentration—0.03 mg/dL,95% CI—0.15‐0.10; I2 = 53%). Conclusions Asymptomatic bacteriuria represents a frequent finding after RT, highlighting the need for appropriate management of this condition. Considering that its treatment did not decrease the risk of the studied complications, antibiotic therapy should start to be questioned, as it has been related to higher rates of antimicrobial resistance and high economic costs.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 94%

Section: Resultsmentioning

confidence: 99%

Section: Risk Of Symptomatic Uti and Impact In Graft Functionmentioning

confidence: 99%

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Systematic review and meta‐analysis of asymptomatic bacteriuria after renal transplantation: incidence, risk of complications, and treatment outcomes

Gómez‐Ochoa

Vega-Vera

2019

Transplant Infectious Dis

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“…8 Another single-center, retrospective study showed an increased progression risk from ASB to symptomatic UTI when treatment was administered, OR 2.8 (95% CI 1.0-7.2). 8 Another single-center, retrospective study showed an increased progression risk from ASB to symptomatic UTI when treatment was administered, OR 2.8 (95% CI 1.0-7.2).…”

mentioning

confidence: 98%

Impact of asymptomatic bacteriuria incidence and management post–kidney transplantation

Bohn

Athans

Kovacs

et al. 2019

Clinical Transplantation

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Objective Urinary tract infections (UTIs) are the most commonly occurring infectious complication following kidney transplantation. Questions remain regarding whether asymptomatic bacteriuria (ASB) should be treated. The aim was to evaluate the incidence and management of ASB in kidney transplant recipients at a large academic medical center. Methods All subjects receiving an isolated kidney transplant between September 2012 and October 2016, and with at least one ASB episode were included. Demographics, symptomatology, and urine culture data were collected on subjects with bacteriuria in the first year post‐transplant. Cultures were classified by symptoms, ASB treatment trends were analyzed, and ASB‐to‐UTI progression was compared between ASB treatment and non‐treatment. Results A total of 527 subjects were transplanted with 64 developing at least one ASB episode. The incidence of ASB was 12.1% and treated 74.6% of the time. Neither lack of ASB treatment (P = 0.463) nor ASB within the first month post‐transplant (P = 0.303) were associated with ASB‐to‐UTI progression. Conclusion Despite high ASB treatment rate, this was not found to be protective against ASB‐to‐UTI progression. ASB within the first month post‐transplant also did not correlate with increased progression risk. These results suggest minimization of ASB treatment in kidney transplant recipients remains an important antimicrobial stewardship target.

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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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Short-Term Outcome of Untreated Versus Treated Asymptomatic Bacteriuria in Renal Transplant Patients

Cited by 17 publications

References 10 publications

Systematic review and meta‐analysis of asymptomatic bacteriuria after renal transplantation: incidence, risk of complications, and treatment outcomes

Systematic review and meta‐analysis of asymptomatic bacteriuria after renal transplantation: incidence, risk of complications, and treatment outcomes

Impact of asymptomatic bacteriuria incidence and management post–kidney transplantation

Opportunities for Antimicrobial Stewardship Interventions Among Solid Organ Transplant Recipients

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