To treat or not to treat ASB? That is the question within 2 months of kidney transplant

Reviewed by Erica Stohs, MD, MPH, University of Nebraska

This randomized controlled trial examined the effectiveness of treating asymptomatic bacteriuria (ASB) on incidence of UTI and graft pyelonephritis within the first 2 months after kidney transplant and found such treatment not to be beneficial.

There is insufficient data to guide clinicians on whether to screen or treat for asymptomatic bacteriuria in newly transplanted kidney patients who are generally at higher risk of infectious complications due to induction immunosuppression and urologic manipulation, often including ureteral stenting. In this study, screening urine cultures were obtained on day of catheter removal, week 3 post-transplant, and before removal of ureteral stent removal. Urine culture growth with >100 thousand CFU/mL of a microorganism was considered ASB. Eighty patients were randomized 1:1 to treatment of ASB vs. no treatment. Primary outcomes were cumulative incidence of UTI and/or graft pyelonephritis and time to first episode. The treated group had the higher incidence of UTI (10 [25%] vs 4 [10%]) and pyelonephritis (6 [15%] vs 1 [2.5%]), though numbers were too small to draw statistical significance. E coli was most common (59%) and over half were ESBL positive. The explanations for these findings were not well delineated and certainly more data are needed in this specific population. In conclusion, this study suggests that screening for and treating ASB early post-kidney transplant should not be standard of care.

Emmanuel Antonio ME, et al. “Treatment of asymptomatic bacteriuria in the first 2 months after kidney transplant: A controlled clinical trial.” Transplant Infectious Disease 2022;24:e13934. DOI: 10.1111/tid.13934

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