Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients

Background: Whether antibiotic treatment of asymptomatic bacteriuria (AB) can prevent acute graft pyelonephritis (AGP) in kidney transplant (KT) recipients has not been elucidated. Methods: In this multicenter, open-label, nonblinded, prospective, noninferiority, randomized controlled trial, we comp...

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Autores: Sabé, Núria|||0000-0003-1697-4347, Oriol, Isabel|||0000-0001-5542-7878, Melilli, Edoardo|||0000-0001-6965-3745, Manonelles, Anna|||0000-0003-2456-388X, Bestard, Oriol|||0000-0001-9468-7920, Polo, Carolina, Los-Arcos, Ibai|||0000-0001-8835-2702, Perelló, Manel|||0000-0003-1859-5279, Garcia, Dolors, Riera, Lluís, Tebé, Cristian|||0000-0003-2320-1385, Len, Oscar|||0000-0002-1819-3141, Moreso, Francesc.|||0000-0002-7267-3963, Cruzado, Josep María, Carratalà, Jordi|||0000-0003-3209-2563
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:223779
Acceso en línea:https://ddd.uab.cat/record/223779
https://dx.doi.org/urn:doi:10.1093/ofid/ofz243
Access Level:acceso abierto
Palabra clave:Asymptomatic bacteriuria
Kidney transplantation
Pyelonephritis
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spelling Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipientsA multicenter randomized trialSabé, Núria|||0000-0003-1697-4347Oriol, Isabel|||0000-0001-5542-7878Melilli, Edoardo|||0000-0001-6965-3745Manonelles, Anna|||0000-0003-2456-388XBestard, Oriol|||0000-0001-9468-7920Polo, CarolinaLos-Arcos, Ibai|||0000-0001-8835-2702Perelló, Manel|||0000-0003-1859-5279Garcia, DolorsRiera, LluísTebé, Cristian|||0000-0003-2320-1385Len, Oscar|||0000-0002-1819-3141Moreso, Francesc.|||0000-0002-7267-3963Cruzado, Josep MaríaCarratalà, Jordi|||0000-0003-3209-2563Asymptomatic bacteriuriaKidney transplantationPyelonephritisBackground: Whether antibiotic treatment of asymptomatic bacteriuria (AB) can prevent acute graft pyelonephritis (AGP) in kidney transplant (KT) recipients has not been elucidated. Methods: In this multicenter, open-label, nonblinded, prospective, noninferiority, randomized controlled trial, we compared antibiotic treatment with no treatment for AB in KT recipients in the first year after transplantation when urinary catheters had been removed. The primary endpoint was the occurrence of AGP. Secondary endpoints included bacteremic AGP, cystitis, susceptibility of urine isolates, graft rejection, graft function, graft loss, opportunistic infections, need for hospitalization, and mortality. Results: We enrolled 205 KT recipients between 2013 and 2015. AB occurred in 41 (42.3%) and 46 (50.5%) patients in the treatment and no treatment groups, respectively. There were no differences in the primary endpoint in the intention-to-treat population (12.2% [5 of 41] in the treatment group vs 8.7% [4 of 46] in the no treatment group; risk ratio, 1.40; 95% confidence interval, 0.40-4.87) or the per-protocol population (13.8% [4 of 29] in the treatment group vs 6.7% [3 of 45] in the no treatment group; risk ratio, 2.07, 95% confidence interval, 0.50-8.58). No differences were found in secondary endpoints, except for antibiotic susceptibility. Fosfomycin (P =.030), amoxicillin-clavulanic (P <.001) resistance, and extended-spectrum ß-lactamase production (P =.044) were more common in KT recipients receiving antibiotic treatment for AB. Conclusions: Antibiotic treatment of AB was not useful to prevent AGP in KT recipients and may increase antibiotic resistance. However, our findings should be regarded with caution, due to the small sample size analyzed. 22019-01-0120192019-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/223779https://dx.doi.org/urn:doi:10.1093/ofid/ofz243reponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengInstituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI111540Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 RD16/0016Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 RD12/0015open accesshttp://purl.org/coar/access_right/c_abf2Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.https://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2237792026-06-06T12:50:31Z
dc.title.none.fl_str_mv Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients
A multicenter randomized trial
title Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients
spellingShingle Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients
Sabé, Núria|||0000-0003-1697-4347
Asymptomatic bacteriuria
Kidney transplantation
Pyelonephritis
title_short Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients
title_full Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients
title_fullStr Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients
title_full_unstemmed Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients
title_sort Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients
dc.creator.none.fl_str_mv Sabé, Núria|||0000-0003-1697-4347
Oriol, Isabel|||0000-0001-5542-7878
Melilli, Edoardo|||0000-0001-6965-3745
Manonelles, Anna|||0000-0003-2456-388X
Bestard, Oriol|||0000-0001-9468-7920
Polo, Carolina
Los-Arcos, Ibai|||0000-0001-8835-2702
Perelló, Manel|||0000-0003-1859-5279
Garcia, Dolors
Riera, Lluís
Tebé, Cristian|||0000-0003-2320-1385
Len, Oscar|||0000-0002-1819-3141
Moreso, Francesc.|||0000-0002-7267-3963
Cruzado, Josep María
Carratalà, Jordi|||0000-0003-3209-2563
author Sabé, Núria|||0000-0003-1697-4347
author_facet Sabé, Núria|||0000-0003-1697-4347
Oriol, Isabel|||0000-0001-5542-7878
Melilli, Edoardo|||0000-0001-6965-3745
Manonelles, Anna|||0000-0003-2456-388X
Bestard, Oriol|||0000-0001-9468-7920
Polo, Carolina
Los-Arcos, Ibai|||0000-0001-8835-2702
Perelló, Manel|||0000-0003-1859-5279
Garcia, Dolors
Riera, Lluís
Tebé, Cristian|||0000-0003-2320-1385
Len, Oscar|||0000-0002-1819-3141
Moreso, Francesc.|||0000-0002-7267-3963
Cruzado, Josep María
Carratalà, Jordi|||0000-0003-3209-2563
author_role author
author2 Oriol, Isabel|||0000-0001-5542-7878
Melilli, Edoardo|||0000-0001-6965-3745
Manonelles, Anna|||0000-0003-2456-388X
Bestard, Oriol|||0000-0001-9468-7920
Polo, Carolina
Los-Arcos, Ibai|||0000-0001-8835-2702
Perelló, Manel|||0000-0003-1859-5279
Garcia, Dolors
Riera, Lluís
Tebé, Cristian|||0000-0003-2320-1385
Len, Oscar|||0000-0002-1819-3141
Moreso, Francesc.|||0000-0002-7267-3963
Cruzado, Josep María
Carratalà, Jordi|||0000-0003-3209-2563
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Asymptomatic bacteriuria
Kidney transplantation
Pyelonephritis
topic Asymptomatic bacteriuria
Kidney transplantation
Pyelonephritis
description Background: Whether antibiotic treatment of asymptomatic bacteriuria (AB) can prevent acute graft pyelonephritis (AGP) in kidney transplant (KT) recipients has not been elucidated. Methods: In this multicenter, open-label, nonblinded, prospective, noninferiority, randomized controlled trial, we compared antibiotic treatment with no treatment for AB in KT recipients in the first year after transplantation when urinary catheters had been removed. The primary endpoint was the occurrence of AGP. Secondary endpoints included bacteremic AGP, cystitis, susceptibility of urine isolates, graft rejection, graft function, graft loss, opportunistic infections, need for hospitalization, and mortality. Results: We enrolled 205 KT recipients between 2013 and 2015. AB occurred in 41 (42.3%) and 46 (50.5%) patients in the treatment and no treatment groups, respectively. There were no differences in the primary endpoint in the intention-to-treat population (12.2% [5 of 41] in the treatment group vs 8.7% [4 of 46] in the no treatment group; risk ratio, 1.40; 95% confidence interval, 0.40-4.87) or the per-protocol population (13.8% [4 of 29] in the treatment group vs 6.7% [3 of 45] in the no treatment group; risk ratio, 2.07, 95% confidence interval, 0.50-8.58). No differences were found in secondary endpoints, except for antibiotic susceptibility. Fosfomycin (P =.030), amoxicillin-clavulanic (P <.001) resistance, and extended-spectrum ß-lactamase production (P =.044) were more common in KT recipients receiving antibiotic treatment for AB. Conclusions: Antibiotic treatment of AB was not useful to prevent AGP in KT recipients and may increase antibiotic resistance. However, our findings should be regarded with caution, due to the small sample size analyzed.
publishDate 2019
dc.date.none.fl_str_mv 2
2019-01-01
2019
2019-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/223779
https://dx.doi.org/urn:doi:10.1093/ofid/ofz243
url https://ddd.uab.cat/record/223779
https://dx.doi.org/urn:doi:10.1093/ofid/ofz243
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI111540
Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 RD16/0016
Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 RD12/0015
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by-nc-nd/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
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repository.mail.fl_str_mv
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