Articles producció científica> Ciències Mèdiques Bàsiques

Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients: A multicenter randomized trial

  • Datos identificativos

    Identificador: imarina:5725032
    Autores:
    Carratalà JCruzado JMoreso FLen ÒTebé CRiera LGarcia DPerelló MArcos IPolo CBestard OManonelles AMelilli EOriol ISabé N
    Resumen:
    © 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.
  • Otros:

    Autor según el artículo: 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
    Departamento: Ciències Mèdiques Bàsiques
    Autor/es de la URV: TEBÉ CORDOMÍ, CRISTIAN
    Palabras clave: 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
    Resumen: © 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.
    Áreas temáticas: Oncology Neurology (Clinical) Microbiology Infectious Diseases Immunology Clinical Neurology
    Acceso a la licencia de uso: https://creativecommons.org/licenses/by/3.0/es/
    Direcció de correo del autor: cristian.tebe@urv.cat
    Identificador del autor: 0000-0003-2320-1385
    ISSN: 23288957
    Fecha de alta del registro: 2020-07-24
    Versión del articulo depositado: info:eu-repo/semantics/publishedVersion
    Enlace a la fuente original: https://academic.oup.com/ofid/article/6/6/ofz243/5494787
    Referencia al articulo segun fuente origial: OPEN FORUM INFECTIOUS DISEASES. (ISSN/ISBN: 23288957). 6(6): OFZ243
    Referencia de l'ítem segons les normes 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
    URL Documento de licencia: https://repositori.urv.cat/ca/proteccio-de-dades/
    DOI del artículo: 10.1093/ofid/ofz243
    Entidad: Universitat Rovira i Virgili
    Año de publicación de la revista: 2019
    Tipo de publicación: Journal Publications
  • Palabras clave:

    Immunology,Infectious Diseases,Microbiology,Neurology (Clinical),Oncology
    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
    Oncology
    Neurology (Clinical)
    Microbiology
    Infectious Diseases
    Immunology
    Clinical Neurology
    23288957
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