Abdullah Tarik Aslan, Lokman Hekim Tanriverdi, Adrian V Hernandez, Umut Akova, Kursat Kutluca, Samuel Chan, Julien Coussement, Arreola Guerra Jose Manuel, Julia Origüen, Núria Sabé, Patrick N A Harris, Murat Akova, David L Paterson
{"title":"无症状细菌尿肾移植受者抗生素的有效性和安全性：随机对照试验的系统评价和荟萃分析。","authors":"Abdullah Tarik Aslan, Lokman Hekim Tanriverdi, Adrian V Hernandez, Umut Akova, Kursat Kutluca, Samuel Chan, Julien Coussement, Arreola Guerra Jose Manuel, Julia Origüen, Núria Sabé, Patrick N A Harris, Murat Akova, David L Paterson","doi":"10.1093/ofid/ofaf502","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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>I</i> <sup>2</sup> = 0%) and that of symptomatic urinary tract infection (UTI) by 18% (1.18 [.78-1.78]; <i>I</i> <sup>2</sup> = 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]), <i>Clostridioides difficile</i> 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.</p><p><strong>Conclusions: </strong>Current evidence does not support routine screening and treatment of posttransplant ASB in KTRs.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 9","pages":"ofaf502"},"PeriodicalIF":3.8000,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461846/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effectiveness and Safety of Antibiotics in Kidney Transplant Recipients With Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis of Randomized Controlled Trials.\",\"authors\":\"Abdullah Tarik Aslan, Lokman Hekim Tanriverdi, Adrian V Hernandez, Umut Akova, Kursat Kutluca, Samuel Chan, Julien Coussement, Arreola Guerra Jose Manuel, Julia Origüen, Núria Sabé, Patrick N A Harris, Murat Akova, David L Paterson\",\"doi\":\"10.1093/ofid/ofaf502\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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>I</i> <sup>2</sup> = 0%) and that of symptomatic urinary tract infection (UTI) by 18% (1.18 [.78-1.78]; <i>I</i> <sup>2</sup> = 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]), <i>Clostridioides difficile</i> 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.</p><p><strong>Conclusions: </strong>Current evidence does not support routine screening and treatment of posttransplant ASB in KTRs.</p>\",\"PeriodicalId\":19517,\"journal\":{\"name\":\"Open Forum Infectious Diseases\",\"volume\":\"12 9\",\"pages\":\"ofaf502\"},\"PeriodicalIF\":3.8000,\"publicationDate\":\"2025-08-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461846/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Open Forum Infectious Diseases\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ofid/ofaf502\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/9/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"IMMUNOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofaf502","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/9/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
Effectiveness and Safety of Antibiotics in Kidney Transplant Recipients With Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
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; I2 = 0%) and that of symptomatic urinary tract infection (UTI) by 18% (1.18 [.78-1.78]; I2 = 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.
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
