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

Area of Science:

• Nephrology
• Transplant Surgery
• Infectious Diseases

Background:

• Asymptomatic bacteriuria (AB) management post-kidney transplantation (KT) is debated.
• Evidence is limited regarding the benefits of treating AB beyond the initial post-transplant period.

Purpose of the Study:

• To evaluate the efficacy of systematic antimicrobial treatment for asymptomatic bacteriuria (AB) in kidney transplant (KT) recipients.
• To determine if treating AB reduces the incidence of acute pyelonephritis and other complications.

Main Methods:

• An open-label, randomized trial involving 112 KT recipients with one or more episodes of AB after two months post-transplant.
• Participants were randomized to receive systematic antimicrobial therapy or no antimicrobial therapy.
• The primary outcome was acute pyelonephritis at 24-month follow-up; secondary outcomes included UTIs, rejection, C. difficile infections, MDR bacteria, graft function, and mortality.

Main Results:

• No significant difference in acute pyelonephritis incidence between the treatment and control groups in both intention-to-treat (7.5% vs. 8.4%) and per-protocol (3.8% vs. 8.0%) analyses.
• No significant differences were observed in any of the secondary outcomes, including infections, graft function, or mortality.
• The odds ratio for acute pyelonephritis was 0.88 (95% CI 0.22-3.47) in the ITT population and 0.46 (95% CI 0.05-4.34) in the PP population.

Conclusions:

• Systematic screening and antimicrobial treatment of asymptomatic bacteriuria (AB) beyond two months post-kidney transplantation (KT) offer no apparent benefit.
• Current evidence does not support routine AB treatment in KT recipients after the early post-transplant phase.
• Further research may be needed to identify specific subgroups that could benefit from AB treatment.