Should Asymptomatic Bacteriuria Be Systematically Treated in Kidney Transplant Recipients? Results From a Randomized Controlled Trial

Abstract

The indication for antimicrobial treatment of asymptomatic bacteriuria (AB) after kidney transplantation (KT) remains controversial. Between January 2011 and December 2013, 112 KT recipients that developed one episode or more of AB beyond the second month after transplantation were included in this open-label trial. Participants were randomized (1:1 ratio) to the treatment group (systematic antimicrobial therapy for all episodes of AB occurring ≤24 mo after transplantation [53 patients]) or control group (no antimicrobial therapy [59 patients]). Systematic screening for AB was performed similarly in both groups. The primary outcome was the occurrence of acute pyelonephritis at 24-mo follow-up. Secondary outcomes included lower urinary tract infection, acute rejection, Clostridium difficile infection, colonization or infection by multidrug-resistant bacteria, graft function and all-cause mortality. There were no differences in the primary outcome in the intention-to-treat population (7.5% [4 of 53] in the treatment group vs. 8.4% [5 of 59] in the control group; odds ratio [OR] 0.88, 95% confidence interval [CI] 0.22-3.47) or the per-protocol population (3.8% [1 of 26] in the treatment group vs. 8.0% [4 of 50] in the control group; OR 0.46, 95% CI 0.05-4.34). Moreover, we found no differences in any of the secondary outcomes. In conclusion, systematic screening and treatment of AB beyond the second month after transplantation provided no apparent benefit among KT recipients (NCT02373085).

Urinary Tract Infections in Renal Transplant Recipients

“…Systematic screening and treatment of AB beyond the second month after transplantation provided no apparent benefit among KT recipients when the occurrence of acute pyelonephritis at 24-month follow-up was considered. The treatment also did not affect the secondary outcomes, which included lower UTI, acute rejection, Clostridium difficile infection, colonization or infection by multidrug-resistant bacteria, graft function and all-cause mortality [29].…”

Old Habits Die Hard: Screening for and Treating Asymptomatic Bacteriuria After Kidney Transplantation

“…We thank Orig€ uen et al for reporting the results of the first randomized controlled trial comparing antibiotics versus no treatment in kidney transplant recipients with asymptomatic bacteriuria (1). In view of the dramatic rise of multidrug-resistant bacteria in solid organ transplantation and because bacteriuria is considered to be the first reason for administrating antibiotics after kidney transplantation, we strongly believe that this research question is of importance.…”

Review of Bacterial Urinary Tract Infection in Kidney Transplant Recipients: Incidence, Risk Factors and Impact on the Graft Survival

“…Giral, et al [22] observed that APN occurring within the first 3 months of the transplant was associated to graft loss. Nevertheless, Abott, et al [23] in a retrospective cohort study of 28.942 renal transplant recipients in the USA observed that UTI occurring 6 months after the trans- the urinary tract, but only a clinical trial has addressed this matter, showing that although in the untreated group, 14% of patients the AB persisted for 7 months, and none developed symptomatic UTI [8].…”

“…Urinary tract infections explain the main use of antibiotics in these patients [6]. It has been described that 25%-47% of renal recipients have at least one symptomatic UTI [7,8].…”

“…Kidney recipients have the highest risk of developing UTI, with an incidence of 0.45 episodes per 1000 days of transplant and a frequency of 7.3%, followed by kidney-pancreas (5%), heart (2.2%), liver (1.6%) and lung recipients (0.7%) [1]. Other authors described an incidence that ranged from 4% to 75% in renal allograft recipients [2][3][4][5][8][9][10][11]. These differences might be explained by the heterogeneity at establishing the definition of UTI and its clinical manifestations-asymptomatic bacteriuria (AB), acute pyelonephritis (APN), lower UTI, urosepsis, etc., different frequency of routine urine culture testing, different follow-up times, different surgical techniques strategies, diversity in the use of antimicrobial prophylaxis, and in the immunosuppression regimens employed and the retrospective design of most of the studies.…”