Author, as appears in the article.: Carratalà J Cruzado J Moreso F Len Ò Tebé C Riera L Garcia D Perelló M Arcos I Polo C Bestard O Manonelles A Melilli E Oriol I Sabé N

Department: Ciències Mèdiques Bàsiques

URV's Author/s: TEBÉ CORDOMÍ, CRISTIAN

Keywords: Urine Culture Renal Replacement Therapy Randomized Controlled Trial Pyelonephritis Prospective Study Priority Journal Outcome Assessment Opportunistic Infection Multicenter Study Mortality Minimum Inhibitory Concentration Male Kidney Transplantation Kidney Graft Kidney Failure Kidney Dysfunction Intention to Treat Analysis Human Hospitalization Graft Rejection Graft Failure Fosfomycin Follow Up Female Extended Spectrum Beta Lactamase disk diffusion Cystitis Controlled Study Clinical Article Blood Analysis Asymptomatic bacteriuria Article Antibiotic Therapy Antibiotic Sensitivity Antibiotic Resistance Amoxicillin Plus Clavulanic Acid Adult

Abstract: © The Author(s) 2019. 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.

Thematic Areas: Oncology Neurology (Clinical) Microbiology Infectious Diseases Immunology Clinical Neurology

licence for use: https://creativecommons.org/licenses/by/3.0/es/

Author's mail: cristian.tebe@urv.cat

Author identifier: 0000-0003-2320-1385

ISSN: 23288957

Record's date: 2020-07-24

Papper version: info:eu-repo/semantics/publishedVersion

Link to the original source: https://academic.oup.com/ofid/article/6/6/ofz243/5494787

Licence document URL: http://repositori.urv.cat/ca/proteccio-de-dades/

Papper original source: OPEN FORUM INFECTIOUS DISEASES. (ISSN/ISBN: 23288957). 6(6): OFZ243

APA: Sabé N, Oriol I, Melilli E, Manonelles A, Bestard O, Polo C, Arcos I, Perelló M, Garcia D, Riera L, Tebé C, Len Ò, Moreso F, Cruzado J, Carratalà J (2019). Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients: A multicenter randomized trial. OPEN FORUM INFECTIOUS DISEASES, 6(6), -. DOI: 10.1093/ofid/ofz243

Article's DOI: 10.1093/ofid/ofz243

Entity: Universitat Rovira i Virgili

Journal publication year: 2019

Publication Type: Journal Publications