Aslan Abdullah Tarik, Tanriverdi Lokman Hekim, Hernandez Adrian V, Akova Umut, Kutluca Kursat, Chan Samuel, Coussement Julien, Manuel Arreola Guerra Jose, Origüen Julia, Sabé Núria, Harris Patrick N A, Akova Murat, Paterson David L
Faculty of Medicine, UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.
Faculty of Medicine, Department of Medical Pharmacology, Inönü University, Malatya, Turkiye.
Open Forum Infect Dis. 2025 Aug 19;12(9):ofaf502. doi: 10.1093/ofid/ofaf502. eCollection 2025 Sep.
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.
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.
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; = 0%) and that of symptomatic urinary tract infection (UTI) by 18% (1.18 [.78-1.78]; = 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]), 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.
Current evidence does not support routine screening and treatment of posttransplant ASB in KTRs.
无症状菌尿（ASB）在肾移植受者（KTRs）中通常会进行系统筛查并用抗生素治疗。我们旨在探讨抗生素治疗在KTRs中ASB管理中的作用。
在Ovid MEDLINE、科学网、PubMed和Cochrane CENTRAL上检索截至2023年5月10日进行的随机对照试验。所有荟萃分析均使用逆方差随机效应模型；对于罕见结局，我们使用Mantel-Haenszel方法。采用ROB-2标准评估偏倚风险。
我们纳入了4项随机对照试验（共478名参与者）。与未治疗相比，抗生素治疗使急性肾盂肾炎风险非显著增加19%（相对风险，1.19[95%置信区间（CI）]，0.72 - 1.94；P = 0%），有症状性尿路感染（UTI）风险增加18%（1.18[0.78 - 1.78]；P = 28%）。全因死亡率（相对风险，1.56[95%CI，0.54 - 4.52]）、移植物丢失（0.80[0.20 - 3.19]）、移植物排斥（0.89[0.46 - 1.70]）、因有症状性UTI住院（0.92[0.48 - 1.76]）、多重耐药菌引起的有症状性UTI（1.31[0.63 - 2.74]）、腹泻（0.75[0.23 - 2.42]）和严重不良事件（1.20[0.75 - 1.91]）在两组间无显著差异，从基线到研究结束时血清肌酐水平的变化也无显著差异（平均差异，0.40mg/dL[95%CI，-0.05至0.85mg/dL]）。在亚组分析和敏感性分析中，抗生素治疗组与未治疗组在任何结局方面均未显示出显著差异。
目前的证据不支持对KTRs移植后ASB进行常规筛查和治疗。
