Impact of asymptomatic bacteriuria incidence and management post–kidney transplantation

Abstract

Objective Urinary tract infections (UTIs) are the most commonly occurring infectious complication following kidney transplantation. Questions remain regarding whether asymptomatic bacteriuria (ASB) should be treated. The aim was to evaluate the incidence and management of ASB in kidney transplant recipients at a large academic medical center. Methods All subjects receiving an isolated kidney transplant between September 2012 and October 2016, and with at least one ASB episode were included. Demographics, symptomatology, and urine culture data were collected on subjects with bacteriuria in the first year post‐transplant. Cultures were classified by symptoms, ASB treatment trends were analyzed, and ASB‐to‐UTI progression was compared between ASB treatment and non‐treatment. Results A total of 527 subjects were transplanted with 64 developing at least one ASB episode. The incidence of ASB was 12.1% and treated 74.6% of the time. Neither lack of ASB treatment (P = 0.463) nor ASB within the first month post‐transplant (P = 0.303) were associated with ASB‐to‐UTI progression. Conclusion Despite high ASB treatment rate, this was not found to be protective against ASB‐to‐UTI progression. ASB within the first month post‐transplant also did not correlate with increased progression risk. These results suggest minimization of ASB treatment in kidney transplant recipients remains an important antimicrobial stewardship target.

A Current Review of the Etiology, Clinical Features, and Diagnosis of Urinary Tract Infection in Renal Transplant Patients

“…Moreover, the treatment of ASB has been associated with antibiotic harmful effects such as the development of multidrug-resistant (MDR) bacteria, a higher incidence of Clostridium difficile diarrhea, and increased healthcare costs [49]. Concern about ASB in the first 1-3 months after transplantation has been raised due to higher immunosuppression and surgical manipulation immediately post-transplant, however, there is not enough evidence to support this [50]. Thus, recent guidelines do not recommend routine screening and treatment of ASB in KT patients [2,3,47], however, screening can be considered in the first 1-3 months post-transplant, and treatment only if there have been two consecutive positive urine cultures for the same bacteria.…”

Systematic review and meta‐analysis of asymptomatic bacteriuria after renal transplantation: incidence, risk of complications, and treatment outcomes

“…Three studies evaluated the incidence of ASB during the first month after KT, finding a pooled incidence of 22% for the first month after KT (Figure S3) with almost no heterogeneity . On the other hand, 10 studies reported data regarding the incidence of ASB during the first year after KT, finding an overall value of 32% (Figure S4) with significantly high heterogeneity (99%) …”

“…Nine studies were included in this meta‐analysis; summaries of each are found in the web‐only Table S1 . When comparing ASB treatment (n = 500) to no treatment (n = 853), the relative risk (RR) for symptomatic UTI occurrence among treated patients was not significantly lower than the risk of not treated ones (OR 1.08; 95% CI 0.63‐1.84), with a moderate heterogeneity ( I 2 35%)(Figure ). On the other hand, three studies evaluated the impact in the graft function, described as the difference in the creatinine serum levels at the beginning and the end of the study.…”

“…Nine studies were included in this meta-analysis; summaries of each are found in the web-only Table S1. 18,19,21,23,28 When comparing ASB treatment (n = 500) to no treatment (n = 853), the relative risk (RR) for symptomatic UTI occurrence among treated patients was not significantly lower than the risk of not treated ones (OR 1.08; 95% CI 0.63-1.84), with a moderate heterogeneity (I 2 35%) 18,19,21,[23][24][25][26][27] (Figure 3).…”

Asymptomatic Bacteriuria in Post Renal Transplant Patients: To Treat or Not?

“…Another observational study by Bohn et al [ 36 ] was conducted to assess the incidence of asymptomatic bacteriuria among patients that underwent kidney transplantation and whether the administration of antibiotics was efficacious in eliminating the infection and enhancing the prognosis or not. They reported that among 527 patients, the incidence was 12.1%, of which, three-fourths were treated were systemic antibiotics.…”