さまよう薬剤師のブログ

感染症治療を考える素材を提供します。最近は意思決定への応用が関心領域。双子と0歳の育児奮闘中。I have Ph.D. but less sense a ID pharmacist (ICPS). Another face is an investor.

Antibiotic treatment versus no treatment for asymptomatic bacteriuria in kidney transplant recipients: a multicenter randomized trial

OFIDから、RCTの報告。

腎臓移植レシピエントにおける無症候性細菌尿症に対する抗生物質治療と無治療の比較:多施設無作為化試験

 

primary endpoint : acute graft pyelonephritis (AGP)

 

academic.oup.com

 

f:id:akinohanayuki:20190527060612j:plain

 

 感想

 

抗菌薬不要の可能性あり。

無症候性細菌尿症の考え方はまだまだトピックですね。

 

 

Background
Whether antibiotic treatment of asymptomatic bacteriuria (AB) can prevent acute graft pyelonephritis (AGP) in kidney transplant (KT) recipients has not been elucidated.
Methods
In this multicenter, randomized, open-labed, nonblinded, prospective, non-inferiority, controlled trial, we compared antibiotic treatment with no treatment for AB in KT recipients in the first year after transplantation when urinary catheters had been removed. The primary endpoint was the occurrence of AGP. Secondary endpoints included bacteremic AGP, cystitis, susceptibility of urine isolates, graft rejection, renal function, graft loss, opportunistic infections, need for hospitalization, and mortality.
Results
We enrolled 205 KT recipients between 2013 and 2015. AB occurred in 41 (42.3%) and 46 (50.5%) patients in the treatment and notreatment groups, respectively. There were no differences in the primary endpoint in the intention-to-treat population (12.2% [5 of 41] in the treatment group vs. 8.7% [4 of 46] in the no treatment group; risk ratio 1.40, 95% confidence interval 0.40-4.87) or the per-protocol population (13.8% [4 of 29] in the treatment group vs. 6.7% [3 of 45] in the no treatment group; risk difference 2.07, 95% confidence interval 0.50-8.58). No differences were found in secondary endpoints, except for antibiotic susceptibility. Fosfomycin (p=0.030) and amoxicillin-clavulanic (p<0.001) resistance, and extended-spectrum β-lactamase production (p=0.044), were more common in KT recipients receiving antibiotic treatment for AB.
Conclusions
Antibiotic treatment of AB was not useful to prevent AGP in KT recipients, and may increase antibiotic resistance. However, our findings should be regarded with caution, due to the small sample size analyzed.