دورية أكاديمية
Antibiotics versus no therapy in kidney transplant recipients with asymptomatic bacteriuria (BiRT): a pragmatic, multicentre, randomized, controlled trial
| العنوان: | Antibiotics versus no therapy in kidney transplant recipients with asymptomatic bacteriuria (BiRT): a pragmatic, multicentre, randomized, controlled trial |
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| المؤلفون: | Coussement, J., Kamar, N., Matignon, M., Weekers, Laurent, Scemla, A., Giral, M., Racapé, J., Alamartine, É., Mesnard, L., Kianda, M., Ghisdal, L., Catalano, C., Broeders, E.N., Denis, O., Wissing, K.M., Hazzan, M., Abramowicz, D., Beq, A., Besse-Hammer, T., Blondel-Halley, M.-N., BORSU, Arnaud, Charpy, V., Couzi, L., Debelle, F., Bello, A.D., de Solere, M., Frade, S., Frimat, L., Grimbert, P., Guerif, P., Hellemans, R., Hodemon-Corne, B., Hougardy, J.-M., Le Moine, A., Lietaer, N., Lortholary, O., Loudon, K., Massart, A., Meersman, E., Ouk, T., Pipeleers, L., Roisin, S., Tollot, S., Verhofstede, S., Wojcik, M., Bacteriuria in Renal Transplantation (BiRT) study group |
| المصدر: | Clinical Microbiology and Infection, 27 (3), 398 - 405 (2021) |
| بيانات النشر: | Elsevier B.V. |
| سنة النشر: | 2021 |
| المجموعة: | University of Liège: ORBi (Open Repository and Bibliography) |
| مصطلحات موضوعية: | Asymptomatic bacteriuria, Bacteriuria, Kidney transplantation, Pyelonephritis, Urinary tract infection, amoxicillin, amoxicillin plus clavulanic acid, antibiotic agent, cephalosporin, ciprofloxacin, cotrimoxazole, fosfomycin trometamol, nitrofurantoin, antiinfective agent, adult, antibiotic resistance, antibiotic therapy, Article, behavior, clinical outcome, clinical trial, controlled study, drug use, female, follow up, graft recipient, human, kidney graft, major clinical study, male |
| الوصف: | peer reviewed ; Objectives: Many transplant physicians screen for and treat asymptomatic bacteriuria (ASB) during post-kidney-transplant surveillance. We investigated whether antibiotics are effective in reducing the occurrence of symptomatic urinary tract infection (UTI) in kidney transplant recipients with ASB. Methods: We performed this multicentre, randomized, open-label trial in kidney transplant recipients who had ASB and were ≥2 months post-transplantation. We randomly assigned participants to receive antibiotics or no therapy. The primary outcome was the incidence of symptomatic UTI over the subsequent 12 months. Results: One hundred and ninety-nine kidney transplant recipients with ASB were randomly assigned to antibiotics (100 participants) or no therapy (99 participants). There was no significant difference in the occurrence of symptomatic UTI between the antibiotic and no-therapy groups (27%, 27/100 versus 31%, 31/99; univariate Cox model: hazard ratio 0.83, 95%CI: 0.50–1.40; log-rank test: p 0.49). Over the 1-year study period, antibiotic use was five times higher in the antibiotic group than in the no-therapy group (30 antibiotic days/participant, interquartile range 20–41, versus 6, interquartile range 0–15, p < 0.001). Overall, 155/199 participants (78%) had at least one further episode of bacteriuria during the follow-up. Compared with the participant's baseline episode of ASB, the second episode of bacteriuria was more frequently caused by bacteria resistant to clinically relevant antibiotics (ciprofloxacin, cotrimoxazole, third-generation cephalosporin) in the antibiotic group than in the no-therapy group (18%, 13/72 versus 4%, 3/83, p 0.003). Conclusions: Applying a screen-and-treat strategy for ASB does not reduce the occurrence of symptomatic UTI in kidney transplant recipients who are more than 2 months post-transplantation. Furthermore, this strategy increases antibiotic use and promotes the emergence of resistant organisms. © 2020 The Authors |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| تدمد: | 1198-743X 1469-0691 |
| العلاقة: | urn:issn:1198-743X; urn:issn:1469-0691; https://orbi.uliege.be/handle/2268/296678Test; info:hdl:2268/296678; https://orbi.uliege.be/bitstream/2268/296678/1/PIIS1198743X20305346.pdfTest; scopus-id:2-s2.0-85092010280; info:pmid:32919076 |
| DOI: | 10.1016/j.cmi.2020.09.005 |
| الإتاحة: | https://doi.org/10.1016/j.cmi.2020.09.005Test https://orbi.uliege.be/handle/2268/296678Test https://orbi.uliege.be/bitstream/2268/296678/1/PIIS1198743X20305346.pdfTest |
| حقوق: | open access ; http://purl.org/coar/access_right/c_abf2Test ; info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.80292866 |
| قاعدة البيانات: | BASE |
Full Text Finder | تدمد: | 1198743X 14690691 |
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| DOI: | 10.1016/j.cmi.2020.09.005 |