Department of Medical Specialities, University Hospital Geneva, Geneva, Switzerland.
Nephrol Dial Transplant. 2011 Dec;26(12):4109-14. doi: 10.1093/ndt/gfr198. Epub 2011 May 17.
No guidelines exist concerning treatment of asymptomatic bacteriuria in renal transplant recipients (RTR). Because of scarce clinical symptoms and fear of complications, such episodes are frequently treated based on subjective criteria without clear clinical benefit, with the risk of selecting resistant pathogens.
We retrospectively analysed the outcome of 334 asymptomatic Escherichia coli (E. coli) and Enterococcus faecalis (E. faecalis) bacteriuria that occurred in 77 RTR later than 1 month post-transplantation. We distinguished: Type I, high-grade bacteriuria with pyuria; Type II, high-grade bacteriuria without pyuria; Type III, low-grade bacteriuria with pyuria and Type IV, low-grade bacteriuria without pyuria.
None of the 334 episodes was followed by acute rejection or chronic pyelonephritis. One hundred and one (30%) episodes were treated [32 (62%) Type I, 38 (45%) Type II, 13 (36%) Type III and 18 (11%) Type IV]. Evolution to symptomatic urinary tract infection (UTI) was similar between treated and untreated episodes (0/101 versus 4/233, P = 0.32). The four UTI resolved favourably without further complication upon treatment. Persistent asymptomatic bacteriuria occurred in 45 (46%) treated episodes (2 Type I, 27 Type II, 8 Type III and 9 Type IV), with selection of resistant pathogen in 35 cases (78%). Spontaneous bacterial clearance occurred in 138 (59%) untreated episodes (15 Type I, 23 Type II, 9 Type III and 91 Type IV). Negative control cultures tended to be more frequent in treated Type I (P = 0.09) and in untreated Type II episodes (P = 0.08).
Restricting antibiotic treatments for asymptomatic low-grade bacteriuria and high-grade bacteriuria in the absence of pyuria, occurring later than 1 month posttransplantation, might be safe in RTR.
目前尚缺乏关于肾移植受者（RTR）无症状菌尿治疗的指南。由于临床症状不明显且担心并发症，此类感染通常基于主观标准进行治疗，而无明确的临床获益，存在选择耐药病原体的风险。
我们回顾性分析了 77 例肾移植后 1 个月以上发生的 334 例无症状大肠埃希菌（E. coli）和粪肠球菌（E. faecalis）菌尿的结果。我们将其分为以下四种类型：I 型，高热性菌尿伴脓尿；II 型，高热性菌尿无脓尿；III 型，低热性菌尿伴脓尿；IV 型，低热性菌尿无脓尿。
334 例菌尿症中均未发生急性排斥反应或慢性肾盂肾炎。101 例（30%）进行了治疗[32 例（62%）为 I 型，38 例（45%）为 II 型，13 例（36%）为 III 型，18 例（11%）为 IV 型]。治疗组与未治疗组的症状性尿路感染（UTI）进展情况相似（0/101 与 4/233，P = 0.32）。经治疗后，4 例 UTI 均顺利痊愈，无进一步并发症。45 例（46%）接受治疗的患者出现持续性无症状菌尿（2 例 I 型，27 例 II 型，8 例 III 型，9 例 IV 型），其中 35 例（78%）发生耐药病原体选择。138 例（59%）未接受治疗的患者出现自发性细菌清除（15 例 I 型，23 例 II 型，9 例 III 型，91 例 IV 型）。治疗组 I 型（P = 0.09）和未治疗组 II 型（P = 0.08）的阴性对照培养更为频繁。
对于肾移植后 1 个月后发生的无症状性低级别菌尿和无脓尿的高级别菌尿，限制抗生素治疗可能是安全的。
