Julien Coussement1, Nassim Kamar2, Marie Matignon3, Laurent Weekers4, Anne Scemla5, Magali Giral6, Judith Racapé7, Éric Alamartine8, Laurent Mesnard9, Mireille Kianda10, Lidia Ghisdal11, Concetta Catalano12, Emine N Broeders12, Olivier Denis13, Karl M Wissing14, Marc Hazzan15, Daniel Abramowicz16. 1. Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; Department of Nephrology, Dialysis and Renal Transplantation, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. Electronic address: juliencoussement@gmail.com. 2. Department of Nephrology and Organ Transplantation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, INSERM U10403, Toulouse, France. 3. Centre d'Investigation Clinique Biothérapie, Hôpital H. Mondor-A. Chenevier, APHP (Assistance Publique-Hôpitaux de Paris), Créteil, France; Université Paris-Est, UMR_S955, UPEC, Créteil, France; INSERM U955, Equipe 21, Créteil, France; Nephrology and Transplantation Department, Hôpital H. Mondor-A. Chenevier, APHP (Assistance Publique-Hôpitaux de Paris), Créteil, France. 4. Department of Nephrology, Centre Hospitalier Universitaire de Liège, Liège, Belgium. 5. Department of Nephrology - Transplantation, Hôpital Necker Enfants Malades, APHP (Assistance Publique-Hôpitaux de Paris), Université Paris Descartes Sorbonne Paris Cité, Paris, France. 6. Institute for Transplantation, Urology and Nephrology (ITUN), Nantes University Hospital, Nantes, France. 7. Research Centre 'Biostatistiques, Epidémiologie et Recherche Clinique', École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium. 8. Department of Nephrology, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France. 9. Department of Nephrology and Kidney Transplantation, Hôpital Tenon, APHP (Assistance Publique-Hôpitaux de Paris), Sorbonne Université, Paris, France. 10. Department of Nephrology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium. 11. Department of Nephrology, Centre Hospitalier EpiCURA, Baudour, Belgium. 12. Department of Nephrology, Dialysis and Renal Transplantation, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium. 13. Laboratory of Microbiology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium. 14. Department of Nephrology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium. 15. Nephrology Department, University Hospital of Lille, INSERM U995, Lille, France. 16. Department of Nephrology, Universitair Ziekenhuis Antwerpen, Universiteit Antwerpen, Antwerp, Belgium.
Abstract
OBJECTIVES: Many transplant physicians screen for and treat asymptomatic bacteriuria (ASB) during post-kidney-transplant surveillance. We investigated whether antibiotics are effective in reducing the occurrence of symptomatic urinary tract infection (UTI) in kidney transplant recipients with ASB. METHODS: We performed this multicentre, randomized, open-label trial in kidney transplant recipients who had ASB and were ≥2 months post-transplantation. We randomly assigned participants to receive antibiotics or no therapy. The primary outcome was the incidence of symptomatic UTI over the subsequent 12 months. RESULTS: One hundred and ninety-nine kidney transplant recipients with ASB were randomly assigned to antibiotics (100 participants) or no therapy (99 participants). There was no significant difference in the occurrence of symptomatic UTI between the antibiotic and no-therapy groups (27%, 27/100 versus 31%, 31/99; univariate Cox model: hazard ratio 0.83, 95%CI: 0.50-1.40; log-rank test: p 0.49). Over the 1-year study period, antibiotic use was five times higher in the antibiotic group than in the no-therapy group (30 antibiotic days/participant, interquartile range 20-41, versus 6, interquartile range 0-15, p < 0.001). Overall, 155/199 participants (78%) had at least one further episode of bacteriuria during the follow-up. Compared with the participant's baseline episode of ASB, the second episode of bacteriuria was more frequently caused by bacteria resistant to clinically relevant antibiotics (ciprofloxacin, cotrimoxazole, third-generation cephalosporin) in the antibiotic group than in the no-therapy group (18%, 13/72 versus 4%, 3/83, p 0.003). CONCLUSIONS: Applying a screen-and-treat strategy for ASB does not reduce the occurrence of symptomatic UTI in kidney transplant recipients who are more than 2 months post-transplantation. Furthermore, this strategy increases antibiotic use and promotes the emergence of resistant organisms.
OBJECTIVES: Many transplant physicians screen for and treat asymptomatic bacteriuria (ASB) during post-kidney-transplant surveillance. We investigated whether antibiotics are effective in reducing the occurrence of symptomatic urinary tract infection (UTI) in kidney transplant recipients with ASB. METHODS: We performed this multicentre, randomized, open-label trial in kidney transplant recipients who had ASB and were ≥2 months post-transplantation. We randomly assigned participants to receive antibiotics or no therapy. The primary outcome was the incidence of symptomatic UTI over the subsequent 12 months. RESULTS: One hundred and ninety-nine kidney transplant recipients with ASB were randomly assigned to antibiotics (100 participants) or no therapy (99 participants). There was no significant difference in the occurrence of symptomatic UTI between the antibiotic and no-therapy groups (27%, 27/100 versus 31%, 31/99; univariate Cox model: hazard ratio 0.83, 95%CI: 0.50-1.40; log-rank test: p 0.49). Over the 1-year study period, antibiotic use was five times higher in the antibiotic group than in the no-therapy group (30 antibiotic days/participant, interquartile range 20-41, versus 6, interquartile range 0-15, p < 0.001). Overall, 155/199 participants (78%) had at least one further episode of bacteriuria during the follow-up. Compared with the participant's baseline episode of ASB, the second episode of bacteriuria was more frequently caused by bacteria resistant to clinically relevant antibiotics (ciprofloxacin, cotrimoxazole, third-generation cephalosporin) in the antibiotic group than in the no-therapy group (18%, 13/72 versus 4%, 3/83, p 0.003). CONCLUSIONS: Applying a screen-and-treat strategy for ASB does not reduce the occurrence of symptomatic UTI in kidney transplant recipients who are more than 2 months post-transplantation. Furthermore, this strategy increases antibiotic use and promotes the emergence of resistant organisms.
Authors: María Ruiz-Ruigómez; Mario Fernández-Ruiz; José Tiago Silva; Elisa Vidal; Julia Origüen; Antonia Calvo-Cano; Enrique Luna-Huerta; Esperanza Merino; Domingo Hernández; Cristina Jironda-Gallegos; Rosa Escudero-Sánchez; Francesca Gioia; Antonio Moreno; Cristina Roca; Elisa Cordero; Darío Janeiro; Beatriz Sánchez-Sobrino; María Milagro Montero; Dolores Redondo; Francisco Javier Candel; Isabel Pérez-Flores; Carlos Armiñanzas; Claudia González-Rico; María Carmen Fariñas; Emilio Rodrigo; Belén Loeches; María O López-Oliva; Miguel Montejo; Ricardo Lauzurica; Juan Pablo Horcajada; Julio Pascual; Amado Andrés; José María Aguado; Francisco López-Medrano Journal: Antimicrob Agents Chemother Date: 2021-02-08 Impact factor: 5.191
Authors: Jens Strohaeker; Victoria Aschke; Alfred Koenigsrainer; Silvio Nadalin; Robert Bachmann Journal: J Clin Med Date: 2021-12-31 Impact factor: 4.241
Authors: David Hernández-Hernández; Bárbara Padilla-Fernández; María Yanira Ortega-González; David Manuel Castro-Díaz Journal: Curr Bladder Dysfunct Rep Date: 2021-12-01
Authors: Loes Oomen; Charlotte Bootsma-Robroeks; Elisabeth Cornelissen; Liesbeth de Wall; Wout Feitz Journal: Front Pediatr Date: 2022-04-08 Impact factor: 3.569
Authors: Jakob E Brune; Michael Dickenmann; Caroline Wehmeier; Daniel Sidler; Laura Walti; Dela Golshayan; Oriol Manuel; Karine Hadaya; Dionysios Neofytos; Aurelia Schnyder; Katia Boggian; Thomas Müller; Thomas Schachtner; Nina Khanna; Stefan Schaub Journal: Am J Transplant Date: 2022-03-26 Impact factor: 9.369