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

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dc.contributor.authorAslan, Abdullah Tarik
dc.contributor.authorTanriverdi, Lokman Hekim
dc.contributor.authorHernandez, Adrian, V
dc.contributor.authorAkova, Umut
dc.contributor.authorKutluca, Kursat
dc.contributor.authorChan, Samuel
dc.contributor.authorCoussement, Julien
dc.date.accessioned2026-04-04T13:33:28Z
dc.date.available2026-04-04T13:33:28Z
dc.date.issued2025
dc.departmentİnönü Üniversitesi
dc.description.abstractBackground 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. State-of-the-art evidence does not support routine screening and treatment of posttransplant bacteriuria in kidney transplant recipients. To understand the effects of antibiotic treatment in patients who develop asymptomatic bacteriuria within 2 months after kidney transplantation, well-conducted large-scale trials are needed.
dc.identifier.doi10.1093/ofid/ofaf502
dc.identifier.issn2328-8957
dc.identifier.issue9
dc.identifier.orcid0000-0002-9999-4003
dc.identifier.orcid0000-0002-2895-0345
dc.identifier.orcid0000-0002-6507-0363
dc.identifier.orcid0000-0002-1768-0503
dc.identifier.orcid0009-0000-9285-5863
dc.identifier.orcid0000-0003-4263-5234
dc.identifier.pmid41018707
dc.identifier.scopus2-s2.0-105016655892
dc.identifier.scopusqualityN/A
dc.identifier.urihttps://doi.org/10.1093/ofid/ofaf502
dc.identifier.urihttps://hdl.handle.net/11616/109180
dc.identifier.volume12
dc.identifier.wosWOS:001578355000001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakScopus
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherOxford Univ Press Inc
dc.relation.ispartofOpen Forum Infectious Diseases
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250329
dc.subjectantibiotic
dc.subjectasymptomatic bacteriuria
dc.subjectkidney transplantation
dc.subjectpyelonephritis
dc.subjecturinary tract infection
dc.titleEffectiveness and Safety of Antibiotics in Kidney Transplant Recipients With Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis of Randomized Controlled Trials
dc.typeArticle

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