Titre :

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

Auteur(s) :

Coussement, Julien [Auteur]
Kamar, Nassim [Auteur]
Centre de Physiopathologie Toulouse Purpan [CPTP]
Université Toulouse III - Paul Sabatier [UT3]
Département de Néphrologie et Transplantation d'organes [CHU Toulouse]
Matignon, Marie [Auteur]
Hôpital Henri Mondor
IMRB - I-BIOT/"Immunorégulation et Biothérapie" [Créteil] [U955 Inserm - UPEC]
Weekers, Laurent [Auteur]
Scemla, Anne [Auteur]
Service Néphrologie et transplantation rénale Adultes [CHU Necker]
Hôpital Necker - Enfants Malades [AP-HP]
Giral, Magali [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Racape, Judith [Auteur]
Institut de transplantation urologie-néphrologie [ITUN]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Alamartine, Eric [Auteur]
Service de Néphrologie Dialyse, Transplantation rénale [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]
Institute for Translational Research in Inflammation - U 1286 [INFINITE]
Service de Néphrologie et Transplantation rénale [CHRU-lille]
Abramowicz, Daniel [Auteur]

Titre de la revue :

Clinical Microbiology and Infection

Nom court de la revue :

Clin. Microbiol. Infect.

Date de publication :

2020-09-09

ISSN :

1469-0691

Mot(s)-clé(s) :

Urinary tract infection
Asymptomatic bacteriuria
Bacteriuria
Kidney transplantation
Pyelonephritis

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [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 ...
Lire la suite >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.Lire moins >

Langue :

Anglais

Comité de lecture :

Oui

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

CHU Lille
Inserm
Université de Lille

Collections :

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

Date de dépôt :

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