Effectiveness and Safety of Antibiotics in Kidney Transplant Recipients With Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Abstract
Abstract Background 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. Methods 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. Results 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; I2 = 0%) and that of symptomatic urinary tract infection (UTI) by 18% (1.18 [.78–1.78]; I2 = 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]), Clostridioides difficile 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…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 478 participants or records.
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