Antibiotics for asymptomatic bacteriuria in kidney transplant recipients.
Coussement J, Scemla A, et al.Cochrane Database Syst Rev. 2018 Feb 1;2:CD011357.
Aims
To conduct a systematic review to determine the benefits and harms of treating asymptomatic bacteriuria in kidney transplant recipients with antimicrobial agents used to prevent symptomatic urinary tract infection (UTI), all-cause mortality and the indirect effects of UTI.
Interventions
The Cochrane Kidney and Transplant Register of Studies (which includes searches of Central, Medline, Embase, conference proceedings, the International Clinical Trials Register, and ClinicalTrials.gov) was searched until 1 September 2017. All randomised controlled trials (RCTs) and quasi-RCTs looking at treatment of asymptomatic bacteriuria in kidney transplant recipients were included. Titles and abstracts were screened independently by two authors and data extraction was carried out independently by two authors using standard data extraction forms. Risk of bias was independently assessed by two authors using the risk of bias assessment tool.
Participants
Two studies (212 participants) were included in the systematic review.
Outcomes
Primary outcomes measured included incidence of symptomatic UTI and incidence of antimicrobial resistance. Secondary measured outcomes included all-cause mortality, graft loss, graft rejection, graft function, hospitalisation for UTI, adverse reactions, and relapse or persistent asymptomatic bacteriuria.
Follow-up
Up to 2 years
CET Conclusions
This Cochrane systematic review investigated the efficacy of treating asymptomatic bacteriuria in kidney transplant recipients with antimicrobial agents to prevent symptomatic urinary tract infections, all-cause mortality and the indirect effects of UTI (acute rejection, graft loss, worsening of graft function). A comprehensive literature search strategy was developed, which identified only two eligible studies: one randomised controlled trial (RCT) and one quasi-RCT. Risk of bias assessment and data extraction was done by two independent reviewers. The quality of the evidence was also assessed using GRADE. The quasi-RCT showed a high risk of bias on all bias domains whereas the RCT showed a high risk of bias for performance, detection and attrition bias but a low risk of bias for all other domains. Data were pooled across two studies (total of 212 patients) but the outcomes of the meta-analysis did not provide sufficient evidence. There are currently three ongoing RCTs on this topic (one of which is the BiRT study that is being conducted in Belgium and France). Including the results of these RCTs in the meta-analyses will help to provide more robust evidence whether to treat asymptomatic bacteriuria in kidney transplant recipients.
Quality notes
Quality assessment not appropriate
Trial registration
None