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Review
. 2024 May 14;13(5):442.
doi: 10.3390/antibiotics13050442.

Systematic Review and Meta-Analysis Provide no Guidance on Management of Asymptomatic Bacteriuria within the First Year after Kidney Transplantation

José Medina-Polo  1 , Eva Falkensammer  2 , Béla Köves  3 , Jennifer Kranz  4   5 , Zafer Tandogdu  6 , Ana María Tapia  7 , Tommaso Cai  8   9 , Florian M E Wagenlehner  10 , Laila Schneidewind  11 , Truls Erik Bjerklund Johansen  9   12   13 ; UTISOLVE Research Group
Affiliations
Review

Systematic Review and Meta-Analysis Provide no Guidance on Management of Asymptomatic Bacteriuria within the First Year after Kidney Transplantation

José Medina-Polo et al. Antibiotics (Basel). .

Abstract

(1) Background: Urinary tract infections (UTIs) are among the most frequent complications in kidney transplant (KT) recipients. Asymptomatic bacteriuria (ASB) may be a risk factor for UTIs and graft rejection. We aimed to evaluate available evidence regarding the benefit of screening and treatment of ASB within the first year after KT. (2) Evidence acquisition: A systematic literature search was conducted in MEDLINE, the Cochrane Library CENTRAL and Embase. Inclusion criteria were manuscripts in English addressing the management of ASB after KT. The PICO questions concerned Patients (adults receiving a KT), Intervention (screening, diagnosis and treatment of ASB), Control (screening and no antibiotic treatment) and Outcome (UTIs, sepsis, kidney failure and death). (3) Evidence synthesis: The systematic review identified 151 studies, and 16 full-text articles were evaluated. Seven were excluded because they did not evaluate the effect of treatment of ASB. There was no evidence for a higher incidence of lower UTIs, acute pyelonephritis, graft loss, or mortality in patients not treated with antibiotics for ASB. Analysis of comparative non-randomized and observational studies did not provide supplementary evidence to guide clinical recommendations. We believe this lack of evidence is due to confounding risk factors that are not being considered in the stratification of study patients.

Keywords: antibiotics; asymptomatic bacteriuria (ASB); graft rejection; kidney failure; kidney transplant; meta-analysis; systematic review; urinary tract infection.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Flowchart with the number of publications evaluated and included in the analysis, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [19].
Figure 2
Figure 2
Analysis of the comparison of the no-treatment groups versus the antibiotics groups in the outcome rate of symptomatic urinary tract infections [10,12,13,14,15,16,17,18,20].
Figure 3
Figure 3
Analysis of the comparison of the no-treatment groups versus the antibiotics groups in the outcome rate of acute pyelonephritis [12,13,15,16,17,18].
Figure 4
Figure 4
Analysis of the comparison of the no-treatment groups versus the antibiotics groups in the outcome hospitalization rate [12,13,15,16,18].
Figure 5
Figure 5
Analysis of the comparison of the no-treatment groups versus the antibiotics groups in the outcome serum creatinine at the end of the follow-up [10,12,18].
Figure 6
Figure 6
Analysis of the comparison of the no-treatment groups versus the antibiotics groups in the outcome rate of graft rejection during the follow-up [13,15,16,17].
Figure 7
Figure 7
Analysis of the comparison of the no-treatment groups versus the antibiotics groups in the outcome rate of graft loss during the follow-up [12,13,16,17].
Figure 8
Figure 8
Analysis of the comparison of the no-treatment groups versus the antibiotics groups in the outcome rate of multidrug-resistant microorganisms [12,13,15,17,18,20].
Figure 9
Figure 9
Analysis of the comparison of the no-treatment groups versus the antibiotics groups in the outcome mortality rate during the follow-up [12,13,17,18].
Figure 10
Figure 10
Risk of bias assessment for the nine included randomized, comparative and observational studies utilizing the risk of bias in non-randomized studies of interventions (ROBINS-I) tool [10,11,12,13,14,15,16,17,18].
See this image and copyright information in PMC

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