Effectiveness and Safety of Antibiotics in Kidney Transplant Recipients With Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Aslan, AT; Tanriverdi, LH; Hernandez, AV; Akova, U; Kutluca, K; Chan, S; Coussement, J; Manuel, AGJ; Origuen, J; Sabe, N; Harris, PNA; Akova, M; Paterson, DL

Author(s): Aslan, AT; Tanriverdi, LH; Hernandez, AV; Akova, U; Kutluca, K; Chan, S; Coussement, J; Manuel, AGJ; Origuen, J; Sabe, N; Harris, PNA; Akova, M; Paterson, DL;
Details: Publication Year 2025-09,Volume 12,Issue #9,Page ofaf502
Journal Title: Open Forum Infectious Diseases
Publication Type: Review
Abstract: BACKGROUND: Asymptomatic bacteriuria (ASB) is generally systematically screened and treated with antibiotics in kidney transplant recipients (KTRs). We aimed to explore the role of antibiotic therapy in management of ASB in KTRs. METHODS: Randomized controlled trials conducted through 10 May 2023 were searched on Ovid MEDLINE, Web of Science, PubMed, and Cochrane CENTRAL. We used inverse variance random-effects models for all meta-analyses; for rare outcomes, we used the Mantel-Haenszel method. ROB-2 criteria were used to assess the risk of bias. RESULTS: We identified 4 randomized controlled trials (including 478 participants). Antibiotic therapy, compared with no therapy, nonsignificantly increased the risk of acute pyelonephritis by 19% (relative risk, 1.19 [95% confidence interval (CI)], .72-1.94; I (2) = 0%) and that of symptomatic urinary tract infection (UTI) by 18% (1.18 [.78-1.78]; I (2) = 28%). The risks of all-cause mortality (relative risk, 1.56 [95% CI, .54-4.52]), graft loss (0.80 [.20-3.19]), graft rejection (0.89 [.46-1.70]), hospital admission due to symptomatic UTI (0.92 [.48-1.76]), symptomatic UTI caused by a multidrug-resistant organism (1.31 [.63-2.74]), Clostridioides difficile diarrhea (0.75 [.23-2.42]), and serious adverse events (1.20 [.75-1.91]) did not differ significantly between groups, nor did the change in serum creatinine level from baseline to the end of the study (mean difference, 0.40 mg/dL [95% CI, -.05 to .85 mg/dL]). No significant differences were demonstrated in any outcomes between antibiotic therapy and no-therapy arms across subgroup and sensitivity analyses. CONCLUSIONS: Current evidence does not support routine screening and treatment of posttransplant ASB in KTRs.
Keywords: antibiotic; asymptomatic bacteriuria; kidney transplantation; pyelonephritis; urinary tract infection
Department(s): Infectious Diseases
Publisher's Version: https://doi.org/10.1093/ofid/ofaf502
Open Access at Publisher's Site: https://doi.org/10.1093/ofid/ofaf502
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2025-10-10 06:00:18

Last Modified: 2025-10-10 06:01:35