Antibiotics versus no therapy in kidney transplant recipients with asymptomatic bacteriuria (BiRT): a pragmatic, multicentre, randomized, controlled trial

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

doi:10.1016/j.cmi.2020.09.005

Article (Scientific journals)

Antibiotics versus no therapy in kidney transplant recipients with asymptomatic bacteriuria (BiRT): a pragmatic, multicentre, randomized, controlled trial

Coussement, J.; Kamar, N.; Matignon, M. et al.

2021 • In Clinical Microbiology and Infection, 27 (3), p. 398 - 405

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https://hdl.handle.net/2268/296678

DOI
10.1016/j.cmi.2020.09.005

PubMed
32919076

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Keywords :

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; asymptomatic bacteriuria; behavior; clinical outcome; clinical trial; controlled study; drug use; female; follow up; graft recipient; human; kidney graft; major clinical study; male; middle aged; multicenter study; open study; parallel design; priority journal; prospective study; pyelonephritis; randomized controlled trial; treatment duration; treatment outcome; urinary tract infection; urine culture; aged; bacteriuria; kidney transplantation; Aged; Anti-Bacterial Agents; Female; Humans; Kidney Transplantation; Male; Middle Aged; Transplant Recipients

Abstract :

[en] 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

Disciplines :

Immunology & infectious disease

Author, co-author :

Coussement, J.; Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium, Department of Nephrology, Dialysis and Renal Transplantation, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium

Kamar, N.; Department of Nephrology and Organ Transplantation, Hôpital Rangueil, Centre Hospitalier Universitaire de Toulouse, Université Paul Sabatier, INSERM U10403, Toulouse, France

Matignon, M.; Centre d'Investigation Clinique Biothérapie, Hôpital H. Mondor-A. Chenevier, APHP (Assistance Publique-Hôpitaux de Paris), Créteil, France, Université Paris-Est, UMR_S955, UPEC, Créteil, France, INSERM U955, Equipe 21, Créteil, France, Nephrology and Transplantation Department, Hôpital H. Mondor-A. Chenevier, APHP (Assistance Publique-Hôpitaux de Paris), Créteil, France

Weekers, Laurent ; Centre Hospitalier Universitaire de Liège - CHU > > Service de néphrologie

Scemla, A.; Department of Nephrology - Transplantation, Hôpital Necker Enfants Malades, APHP (Assistance Publique-Hôpitaux de Paris), Université Paris Descartes Sorbonne Paris Cité, Paris, France

Giral, M.; Institute for Transplantation, Urology and Nephrology (ITUN), Nantes University Hospital, Nantes, France

Racapé, J.; Research Centre ‘Biostatistiques, Epidémiologie et Recherche Clinique’, École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium

Alamartine, É.; Department of Nephrology, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France

Mesnard, L.; Department of Nephrology and Kidney Transplantation, Hôpital Tenon, APHP (Assistance Publique-Hôpitaux de Paris), Sorbonne Université, Paris, France

Kianda, M.; Department of Nephrology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium

More authors (36 more)

Language :

English

Title :

Antibiotics versus no therapy in kidney transplant recipients with asymptomatic bacteriuria (BiRT): a pragmatic, multicentre, randomized, controlled trial

Publication date :

2021

Journal title :

Clinical Microbiology and Infection

ISSN :

1198-743X

eISSN :

1469-0691

Publisher :

Elsevier B.V.

Volume :

Issue :

Pages :

398 - 405

Peer reviewed :

Peer Reviewed verified by ORBi

Funding text :

All authors have completed the ICMJE uniform disclosure form. Julien Coussement reports research grants from Fonds Erasme pour la Recherche Médicale, Fonds David et Alive Van Buuren, and Fonds Carine Vyghen (during the conduct of the study), and personal fees from Sanofi (outside the submitted work). Magali Giral reports grants from Novartis and Sanofi (outside the submitted work), and travel funding and/or honoraria from Astellas, Chiesi, Novartis, Sandoz and Sanofi (also outside the submitted work). Nassim Kamar reports personal fees from Abbvie, Amgen, Astellas, Biotest, CSL Behring, Chiesi, Gilead, Fresenius Medical care, Merck Sharp and Dohme, Neovii, Novartis Pharma, Sanofi, Sandoz, and Shire (outside the submitted work). Anne Scemla reports non-financial support from Bristol-Myers Squibb (outside the submitted work). Other authors declare no competing interests. This work was supported by three research grants: Fonds Erasme pour la Recherche Médicale , Fonds David et Alive Van Buuren , and Fonds Carine Vyghen (all to JC). The funders of the study had no role in the study design, in the collection, analysis and interpretation of data, or in the report writing.

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