Consequences of treated versus untreated asymptomatic bacteriuria in the first year following kidney transplantation: retrospective observational study

• Published in: European journal of clinical microbiology & infectious diseases Vol. 32; no. 1; pp. 127 - 131
• Main Authors: Green, H., Rahamimov, R., Goldberg, E., Leibovici, L., Gafter, U., Bishara, J., Mor, E., Paul, M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 2013; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Antibiotics; Asymptomatic; Asymptomatic Diseases; Bacteria; Bacterial diseases; Bacterial diseases of the urinary system; Bacteriuria - drug therapy; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cohort analysis; Cohort Studies; Creatinine; Documentation; Female; Glomerular Filtration Rate; Hospitalization; Hospitalization - statistics & numerical data; Hospitals; Human bacterial diseases; Humans; Infectious diseases; Internal Medicine; Kidney - physiopathology; Kidney Transplantation; Kidney transplants; Length of Stay; Male; Medical Microbiology; Medical sciences; Middle Aged; Mortality; Observational studies; Patients; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Analysis; Transplantation; Treatment Outcome; Urinary tract infections; Urinary Tract Infections - epidemiology; Urine; Urogenital system; Variables; Israel; Mycophenolate Mofetil; Untreated Patient; Antibiotic Treatment; Bacteriuria; Pyelonephritis; Infection; Treatment; Microbiology; Surgery; Asymptomatic; Comparative study; Kidney transplantation
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-012-1727-2

Asymptomatic bacteriuria (AB) is frequent among kidney transplant patients during the first year post transplantation. Currently, there are no clear guidelines for the antibiotic treatment of AB among these patients. We examined the outcomes of treatment versus no treatment of AB in kidney transplant patients during the first year post transplantation. A retrospective cohort study including adults >16 years of age transplanted in one center between 1/2004 and 12/2010 was undertaken. The primary outcome was a composite of hospitalization for symptomatic urinary tract infection (UTI) or more than 25 % reduction in the estimated glomerular filtration rate (eGFR) 30 days after the documentation of AB. Secondary outcomes included symptomatic UTIs following the episode of AB, persistent recurrent AB, total days in hospital, mortality, adverse events, and resistance development. A total of 112 patients with AB fulfilled the inclusion criteria. Twenty-two patients received antibiotic treatment (19.6 %), while 90 patients did not. The primary outcome occurred in 4/22 (18.2 %) of the treated patients versus 5/90 (5.6 %) of the untreated patients [odds ratio (OR) = 3.78, 95 % confidence interval (CI) 0.9–15]. The risk of developing symptomatic UTI after AB was almost three times higher ( p  < 0.05) and the total number of hospitalization days at 6 months post AB was also significantly higher ( p  < 0.026) in the treated group. No patient died during the study period. UTI caused by bacteria resistant to the antibiotic used for the treatment of AB occurred in 36 % of the treated patients. We observed no benefit for the antibiotic treatment of AB in the short- and long-term follow-up. A prospective observational study is needed.