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系统评价和荟萃分析对肾移植后第一年内无症状菌尿的管理未提供指导。

Systematic Review and Meta-Analysis Provide no Guidance on Management of Asymptomatic Bacteriuria within the First Year after Kidney Transplantation.

作者信息

Medina-Polo José, Falkensammer Eva, Köves Béla, Kranz Jennifer, Tandogdu Zafer, Tapia Ana María, Cai Tommaso, Wagenlehner Florian M E, Schneidewind Laila, Bjerklund Johansen Truls Erik

机构信息

Department of Urology, Hospital Universitario 12 de Octubre imas12, 28040 Madrid, Spain.

Department of Urology, Klinikum Wels-Grieskirchen, 4710 Wels, Austria.

出版信息

Antibiotics (Basel). 2024 May 14;13(5):442. doi: 10.3390/antibiotics13050442.

DOI:10.3390/antibiotics13050442
PMID:38786170
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11117648/
Abstract

(1) Background: Urinary tract infections (UTIs) are among the most frequent complications in kidney transplant (KT) recipients. Asymptomatic bacteriuria (ASB) may be a risk factor for UTIs and graft rejection. We aimed to evaluate available evidence regarding the benefit of screening and treatment of ASB within the first year after KT. (2) Evidence acquisition: A systematic literature search was conducted in MEDLINE, the Cochrane Library CENTRAL and Embase. Inclusion criteria were manuscripts in English addressing the management of ASB after KT. The PICO questions concerned Patients (adults receiving a KT), Intervention (screening, diagnosis and treatment of ASB), Control (screening and no antibiotic treatment) and Outcome (UTIs, sepsis, kidney failure and death). (3) Evidence synthesis: The systematic review identified 151 studies, and 16 full-text articles were evaluated. Seven were excluded because they did not evaluate the effect of treatment of ASB. There was no evidence for a higher incidence of lower UTIs, acute pyelonephritis, graft loss, or mortality in patients not treated with antibiotics for ASB. Analysis of comparative non-randomized and observational studies did not provide supplementary evidence to guide clinical recommendations. We believe this lack of evidence is due to confounding risk factors that are not being considered in the stratification of study patients.

摘要

(1) 背景：尿路感染（UTIs）是肾移植（KT）受者中最常见的并发症之一。无症状菌尿（ASB）可能是UTIs和移植肾排斥反应的危险因素。我们旨在评估有关KT术后第一年ASB筛查和治疗益处的现有证据。(2) 证据获取：在MEDLINE、Cochrane图书馆CENTRAL和Embase中进行了系统的文献检索。纳入标准为英文撰写的关于KT术后ASB管理的手稿。PICO问题涉及患者（接受KT的成年人）、干预措施（ASB的筛查、诊断和治疗）、对照（筛查且不使用抗生素治疗）和结局（UTIs、败血症、肾衰竭和死亡）。(3) 证据综合：系统评价共识别出151项研究，对16篇全文进行了评估。7篇因未评估ASB治疗效果而被排除。没有证据表明未接受ASB抗生素治疗的患者发生下UTIs、急性肾盂肾炎、移植肾丢失或死亡的发生率更高。对比较性非随机和观察性研究的分析未提供指导临床建议的补充证据。我们认为缺乏证据是由于在研究患者分层中未考虑混杂危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/8360391c7a9b/antibiotics-13-00442-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/21edd55b89b1/antibiotics-13-00442-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/13cd127ce2ac/antibiotics-13-00442-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/a369bb3ed756/antibiotics-13-00442-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/58ecf70366c7/antibiotics-13-00442-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/77af40dc4fd0/antibiotics-13-00442-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/1262a83dcede/antibiotics-13-00442-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/462c8f6494da/antibiotics-13-00442-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/c4dfbeb8c077/antibiotics-13-00442-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/1c567b2c9186/antibiotics-13-00442-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/8360391c7a9b/antibiotics-13-00442-g010.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/21edd55b89b1/antibiotics-13-00442-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/13cd127ce2ac/antibiotics-13-00442-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/a369bb3ed756/antibiotics-13-00442-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/58ecf70366c7/antibiotics-13-00442-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/77af40dc4fd0/antibiotics-13-00442-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/1262a83dcede/antibiotics-13-00442-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/462c8f6494da/antibiotics-13-00442-g007.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/c4dfbeb8c077/antibiotics-13-00442-g008.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/1c567b2c9186/antibiotics-13-00442-g009.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/679d/11117648/8360391c7a9b/antibiotics-13-00442-g010.jpg

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