Title :

Antibiotics versus no therapy in kidney transplant recipients with asymptomatic bacteriuria (birt): a pragmatic, multicentre, randomised controlled trial

Author(s) :

Coussement, Julien [Auteur]
Kamar, Nassim [Auteur]
Département de Néphrologie et Transplantation d'organes [CHU Toulouse]
Université Toulouse III - Paul Sabatier [UT3]
Centre de Physiopathologie Toulouse Purpan [CPTP]
Matignon, Marie [Auteur]
IMRB - I-BIOT/"Immunorégulation et Biothérapie" [Créteil] [U955 Inserm - UPEC]
Hôpital Henri Mondor
Weekers, Laurent [Auteur]
Scemla, Anne [Auteur]
Hôpital Necker - Enfants Malades [AP-HP]
Service Néphrologie et transplantation rénale Adultes [CHU Necker]
Giral, Magali [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Racape, Judith [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Institut de transplantation urologie-néphrologie [ITUN]
Alamartine, Eric [Auteur]
Service de Néphrologie [CHU Saint Etienne]
Mesnard, Laurent [Auteur]
CHU Tenon [AP-HP]
Kianda, Mireille [Auteur]
Ghisdal, Lidia [Auteur]
Catalano, Concetta [Auteur]
Broeders, Emine N. [Auteur]
Denis, Olivier [Auteur]
Wissing, Karl M. [Auteur]
Hazzan, Marc [Auteur]
Service de Néphrologie et Transplantation rénale [CHRU-lille]
Institute for Translational Research in Inflammation - U 1286 [INFINITE]
Abramowicz, Daniel [Auteur]

Journal title :

Clinical Microbiology and Infection

Abbreviated title :

Clin. Microbiol. Infect.

Publication date :

2020-09-09

ISSN :

1469-0691

Keyword(s) :

Urinary tract infection
Asymptomatic bacteriuria
Bacteriuria
Kidney transplantation
Pyelonephritis

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

OBJECTIVE: 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 ...
Show more >OBJECTIVE: 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.Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Inserm
Université de Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Submission date :

2021-07-06T12:50:10Z
2024-03-28T10:41:08Z