Antonio Mendoza Enciso Emmanuel, Cassandra Barajas García Carolina, Emiliano Rodriguez Jimenez Dante, Guadalupe Ortiz Lopez Margarita, Lilian Reza Escalera Ana, Teresa Tiscareño Gutiérrez María, Mario Gonzalez Gamez, Ivan Rodríguez Correa Gustavo, Mercedes Ramos Velazco, Alfredo Chew Wong, Rafael Reyes Acevedo, Lilian Guerrero Barrera Alma, Manuel Arreola Guerra Jose
Department of Internal Medicine, Hospital Centenario Miguel Hidalgo, Aguascalientes, Mexico.
Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico.
Transpl Infect Dis. 2022 Dec;24(6):e13934. doi: 10.1111/tid.13934. Epub 2022 Aug 28.
The incidence of urinary tract infections (UTIs) in the first 2 months postrenal transplantation (pRT) is very high. We evaluate the efficacy of asymptomatic bacteriuria (AB) screening and treatment on the incidence of UTI in the first 2 months pRT METHODS: We conducted a randomized controlled clinical trial. A urine culture was obtained in all patients on the day of the bladder catheter removal, on week three, and before removal of the ureteral catheter. The intervention group received treatment for AB. The control group did not receive treatment. The primary outcomes were the cumulative incidence of UTI and/or graft pyelonephritis and the time to the first episode of UTI and/or graft pyelonephritis RESULTS: Eighty patients were randomized, 40 in each group, and the median follow-up was 63 days (IQR 54-70). The average age was 29.8 years and 33.7% (n = 27) were women. The incidences of UTI (n = 10, 25 % vs. n = 4, 10%, p = .07) and pyelonephritis (n = 6, 15% vs. n = 1, 2.5%, p = .04) were greater in the intervention group, as also shown in the survival analysis: UTI (HR2.8, 95% CI 0.8-9.1, p = .07) and pyelonephritis (HR 6.5, 95% CI 0.8-54.7, p = .08), respectively. The most commonly isolated bacterium was Escherichia coli (n = 28, 59.5%), and over half were E. coli with extended-spectrum beta-lactamases (n = 15). A major limitation was not obtaining the calculated sample size due to a delay in patient recruitment resulting from the COVID-19 pandemic CONCLUSION: Treatment of AB in the first 2 months pRT does not decrease the incidence of UTI or graft pyelonephritis and may actually increase their frequency. Routine treatment of AB during the first months after renal transplantation should not be a standard procedure.
肾移植术后（pRT）前2个月内尿路感染（UTIs）的发生率非常高。我们评估无症状菌尿（AB）筛查及治疗对肾移植术后前2个月内UTI发生率的影响。方法：我们进行了一项随机对照临床试验。在所有患者拔除膀胱导管当天、第3周以及拔除输尿管导管前采集尿培养样本。干预组接受AB治疗，对照组不接受治疗。主要结局指标为UTI和/或移植肾肾盂肾炎的累积发生率以及首次发生UTI和/或移植肾肾盂肾炎的时间。结果：80例患者被随机分组，每组40例，中位随访时间为63天（四分位间距54 - 70天）。平均年龄为29.8岁，33.7%（n = 27）为女性。干预组UTI（n = 10，25% vs. n = 4，10%，p = 0.07）和肾盂肾炎（n = 6，15% vs. n = 1，2.5%，p = 0.04）的发生率更高，生存分析结果也显示如此：UTI（风险比2.8，95%置信区间0.8 - 9.1，p = 0.07）和肾盂肾炎（风险比6.5，95%置信区间0.8 - 54.7，p = 0.08）。最常分离出的细菌是大肠埃希菌（n = 28，59.5%），超过一半是产超广谱β-内酰胺酶的大肠埃希菌（n = 15）。一个主要局限性是由于2019年冠状病毒病疫情导致患者招募延迟，未达到计算的样本量。结论：肾移植术后前2个月内AB的治疗并不能降低UTI或移植肾肾盂肾炎的发生率，实际上可能会增加其发生频率。肾移植术后最初几个月常规治疗AB不应成为标准做法。
