Antibiotics versus no treatment for asymptomatic bacteriuria in kidney transplant recipients

Patient or population: adult kidney transplant recipients
Intervention: antibiotics¹
Comparison: no treatment¹

Symptomatic UTI

Follow‐up: 12 to 22 months

RR 0.86 (0.51 to 1.45)

200 ² (2 studies)

Low ³

⊕⊕⊝⊝

Antimicrobial resistance

Mean follow‐up: 16.9 months

RR 1.21 (0.60 to 2.41)

112 (1 study)

Low ⁴

⊕⊕⊝⊝

All‐cause mortality

Mean follow‐up: 16.9 months

RR 2.23 (0.21, 23.86)

112 (1 study)

Low ⁵

⊕⊕⊝⊝

Graft loss

Mean follow‐up: 16.9 months

RR 1.11 (0.07 to 17.36)

112 (1 study)

Low ⁵

⊕⊕⊝⊝

Acute graft rejection

Mean follow‐up: 16.9 months

RR 0.93 (0.44 to 1.97)

112 (1 study)

Low ⁶

⊕⊕⊝⊝

Hospitalisation for UTI

Mean follow‐up: 16.9 months

RR 0.74 (0.13 to 4.27)

112 (1 study)

Low ⁵

⊕⊕⊝⊝

Graft function (creatinine at end of study)

Follow‐up: 12 to 22 months

200 ² (2 studies)

Low ^{7, 8}

⊕⊕⊝⊝

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RD: risk difference; RR: risk ratio; UTI: urinary tract infection

¹ The two included studies compared antibiotics versus no treatment, with choice of antibiotics depending on antimicrobial susceptibility testing results. As participants could have had multiple episodes of asymptomatic bacteriuria during the follow‐up period, participants from the intervention group were retreated with antibiotics if asymptomatic bacteriuria recurred during the follow‐up period in both studies. Duration of antibiotics therapy ranged from 3 to 10 days for the first episode of asymptomatic bacteriuria.

² 212 participants included but data provided for 200 participants.

³ Neither study attempted to blind participants, personnel or data analysts. As symptoms of UTI are partly subjective, we anticipated this would put the results at risk of being biased in favour of antibiotic treatment.

⁴ Samples could be collected both in case of symptoms of UTI or as part of routine screening.

⁵ The confidence interval crosses the line of no effect but does not rule out a significant effect of antibiotics on mortality and/or graft loss.

⁶ No systematic graft biopsy performed during the study follow‐up. Not all episodes of allograft rejection were biopsy‐proven.

⁷ Graft function was evaluated using creatinine at end of study, despite different values between groups at time of inclusion. We were unable to pool the data for change in graft function from baseline to end of study (data missing for one study).

⁸ No significant effect of antibiotics on change in graft function from baseline to end of study in both studies.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect