Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients: a survey of current practice in Europe

Julien Coussement (1) , Umberto Maggiore (2) , Oriol Manuel (3) , Anne Scemla (4) , Francisco López-Medrano , Evi Nagler , José María Aguado , Daniel Abramowicz , Brigitte Adams , Caroline Agnelli , Oana Ailioaie (5) , Hamdi Akan , Lucile Amrouche , Amado Andrés , Dany Anglicheau (6) , Paul Arnouts , Marije Baas , Cristian Balgradean , Bert Bammens , Yuri Battaglia , Thomas Baudoux , Bert Berto , Isabelle Binet , Claus Bistrup , Renzo Bonofiglio , Jean-Louis Bosmans , Yassine Bouatou , Nicolas Bouvier (7) , Philippe Braconnier , Edwin Bredewold , Nilufer Broeders , Philippe Brunet (8) , Matthias Buchler (9) , Klemens Budde (10) , Fanny Buron (11) , Stéphane Burtey (12, 13) , Andrea Buscaroli , Stefan Büttner , Catherine Byrne , Rossana Caldara , Elisabeth Cassuto (14) , Concetta Catalano , Guilhem Cavaille , Alice Corbel (15) , Lionel Couzi (16) , Marta Crespo , Sunil Daga , Frederic Debellé (17) , Ivana Dedinska , Paul Devine , Michael Dickenmann , Max Dratwa , Lubos Drgona , Magdalena Durlik , Maria Francesca Egidi , Pedro Errasti , Isabelle Etienne (18) , María Carmen Fariñas , Thomas Fehr , Mario Fernández-Ruiz (19) , Paraskevi Founta , Konstantinos Fourtounas , Eleni Frangou , Luc Frimat (20) , Luc Furian , Maria Garjau , Valérie Garrigue (21) , Philippe Gatault (9) , Colin Geddes , Paul Gerlinger , Eric Gheuens , Lidia Ghisdal , Paul Gibbs , Magali Giral (22) , Sophie Girerd (20) , Dela Golshayan (3) , Athina Gompou , Paolo Antonio Grossi , Gabriele Guglielmetti , Luis Guirado , Karine Hadaya , Marc Hazzan (23) , Mark Helbert , Rachel Hellemans , Katharina Heller , Uwe Heemann (24) , Manu Henckes , Domingo Hernandez , Alexandre Hertig (25) , Christian Hiesse (26) , Luuk Hilbrands , Rachel Hilton , Cédric Hirzel (27) , Juan Pablo Horcajada , Jean-Michel Hougardy , Uyen Huynh-Do (28) , Alma Idrizi , Khalid Ismaili , Carlos Jiménez (29) , Noemie Jourde-Chiche (13) , Nassim Kamar (30) , Hannah Kaminski (31) , Julia Kanter , Alexandre Karras (32) , Delphine Kemlin , Petar Kes , Mireille Kianda , Maria Klinger , Simon A.B. Knight (33) , Irene Koneth , Anita Krrashi , Dirk Kuypers (34) , Anne Langlois , Philippe Lang (35) , Ricardo Lauzurica , Alain Le Moine , David Lebeaux (36) , Christophe Legendre (37) , Anne Lemy , Oscar Len , Vassilios Liakopoulos , Monika Lichodziejewska-Niemierko , Maria Yague , Kai Lopau , Philippe Madhoun , Maria Magott-Procelewska , Shafi Malik , Anna Manonelles Montero , Marc Marchini , Alessandra Marega , Maria Mariat , Mark Mark , Pierre-Yves Martin , Leyre Martín , Paloma Leticia Martín , Annick Massart , Marie Matignon (38) , Stéphane Maurel , Auxiliadora Mazuecos , Christina Melexopoulou , Edoardo Melilli , Esperanza Merino , Enisa Mesic , Piergiorgio Messa (39) , Magdalena Michalak , Enrico Minetti , Grigorios Miserlis , Miguel Montejo , Diego Moriconi , Clément Mottola (40) , Georges Mourad (41) , Thomas Mueller (42) , Patricia Muñoz (43) , Alexander Nabokow , Maarten Naesens (44) , Maria Nikodimopoulou , Rainer Oberbauer (45) , María Olmedo , Jonathon Olsburgh , Gabriel Oniscu , Lara Aygen Øzbay , Alessandra Palmisano , Aikaterini Papagianni , Mario Papasotiriou , Angelica Parodi , Rob Parry , Julio Pascual , Isabel Pérez Flores , María Pérez-Sáez , Licia Peruzzi , Camille Petit-Hoang (25) , Paul Phelan , Evangeline Pillebout (46) , Giovanni Piotti (47) , Lissa Pipeleers , Christos Pleros , Joyce Popoola , Renzo Pretagostini , Erasmia Psimenou , Josep Puig (48) , Cédric Rafat (25) , Silvie Rajnochova Bloudickova , Irena Rambabova Bushljetikj , Marina Ratkovic , Dolores Redondo , Tomas Reischig , Thomas Robert (25) , Luis Ferrero , Merita Rroji , Przemyslaw Rutkowski , Alicja Rydzewska-Rosolowska , Núria Sabé , Dil Sahali (49) , Bernd Salzberger , Rafael San-Juan , Beatriz Sánchez Sobrino , Silvio Sandrini , Lídia Santos , Roxana Sava , Stefan Schaub , Johan Schikowski (20) , Betoul Schvartz , Urban Sester , Jose Tiago Silva , Renaud Snanoudj (37) , Danio Somenzi , Søren Sørensen (50) , Georgios Spanos , Jürg Steiger (51) , Barbara Suwelack , Eleni Theodoropoulou , Eric Thervet (37) , Stefan Thorban , Giuliana Tognarelli , Yasmina Tournay , Leïla Tricot (52) , Patrizia Tulissi , Henri Vacher-Coponat (53) , Maricela Valerio , W van Der Meijden , Henk van Hamersvelt , Steven van Laecke (54) , Alain Vandivinit , Raymond Vanholder (55) , Massimiliano Veroux , Ondrej Viklicky (56) , Emanuela Vigo , Claudio Viscoli (57) , W Watschinger , W Weekers , W Welberry Smith , W Martin , Nereida Zeneli , Angelos Zervos , Lada Zibar , Julien Zuber (58) , Bianca Zukunft

1 Department Infections Diseases
2 Azienda Ospedaliero-Universitaria di Parma
3 CHUV - Centre Hospitalier Universitaire Vaudois [Lausanne]
4 Réseau CENTAURE
5 Service de Maladies Infectieuses et Tropicales [CHU Pitié-Salpêtrière]
6 Service Néphrologie et transplantation rénale Adultes [CHU Necker]
7 U775 (IFR95) - Bases moléculaires de la réponse aux xénobiotiques
8 IEMN - Institut d’Électronique, de Microélectronique et de Nanotechnologie - UMR 8520
9 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
10 Department of Nephrology
11 Hôpital Edouard Herriot [CHU - HCL]
12 Chirurgie urologique et transplantation rénale [Hôpital de la Conception - APHM]
13 C2VN - Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research
14 Service de néphrologie
15 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
16 Service de Néphrologie-transplantation-dialyse [Bordeaux]
17 UMons - Université de Mons
18 CHU Rouen
19 Unit Infectious Diseases
20 Service de Néphrologie [CHRU Nancy]
21 Service de Pédiatrie spécialisée
22 U1064 Inserm - CRTI - Centre de Recherche en Transplantation et Immunologie
23 Université de Lille
24 Department of Pulmonary Medicine
25 Service d'Urgences néphrologiques et transplantation rénale [CHU Tenon]
26 Service de néphrologie (CHU de Dijon)
27 Swiss Transplantation Cohort Study
28 Department of Nephrology and Hypertension, and Department of Clinical Research
29 CIMAR - Centro de Investigación en Ciencias del Mar y Limnología
30 Service de Néphrologie - Hypertension Artérielle Dialyse - Transplantation
31 UB - Université de Bordeaux
32 HEGP - Hôpital Européen Georges Pompidou [APHP]
33 Department of Medicine, Division of Hematology-Oncology
34 Department of Nephrology and Renal Transplantation
35 UGA UFRM - Université Grenoble Alpes - UFR Médecine
36 IMAGINE - U1163 - Imagine - Institut des maladies génétiques
37 Service de néphrologie adultes [CHU Necker]
38 IMRB - Institut Mondor de Recherche Biomédicale
39 Division of Nephrology
40 UL - Université de Lorraine
41 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
42 Department of Laboratory Medicine
43 Clinical Microbiology and Infectious Diseases Department
44 University Hospitals Leuven [Leuven]
45 Department of Internal Medicine III
46 Service de rhumatologie
47 Kidney and Pancreas Transplantation
48 Department d'enginyeria quimica agraria i tecnologia agroalimentaria
49 Néphrologie Transplantation
50 Section of Microbiology [Copenhagen]
51 University Hospital Basel [Basel]
52 Service Néphrologie Transplantation Rénale
53 Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM]
54 Renal Division
55 Nephrology Section [Ghent]
56 Dept. of Nephrology
57 Division of Infectious Diseases
58 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)

Background Asymptomatic bacteriuria is frequent in kidney transplant recipients (KTRs). However, there is no consensus on diagnosis or management. We conducted a European survey to explore current practice related to the diagnosis and management of asymptomatic bacteriuria in adult KTRs. Methods A panel of experts from the European Renal Association–European Dialysis Transplant Association/Developing Education Science and Care for Renal Transplantation in European States working group and the European Study Group for Infections in Compromised Hosts of the European Society of Clinical Microbiology and Infectious Diseases designed this cross-sectional, questionnaire-based, self-administered survey. Invitations to participate were e-mailed to European physicians involved in the care of KTRs. Results Two hundred and forty-four participants from 138 institutions in 25 countries answered the survey (response rate 30%). Most participants [72% (176/244)] said they always screen for asymptomatic bacteriuria in KTRs. Six per cent (15/240) reported never treating asymptomatic bacteriuria with antibiotics. When antimicrobial treatment was used, 24% of the participants (53/224) said they would start with empirical antibiotics. For an episode of asymptomatic bacteriuria caused by a fully susceptible microorganism and despite no contraindications, a majority of participants (121/223) said they would use a fluoroquinolone (n = 56), amoxicillin/clavulanic acid (n = 38) or oral cephalosporins (n = 27). Conclusions Screening for and treating asymptomatic bacteriuria are common in KTRs despite uncertainties around the benefits and harms. In an era of antimicrobial resistance, further studies are needed to address the diagnosis and management of asymptomatic bacteriuria in these patients.

Domains: Life Sciences [q-bio]

Julien Coussement, Umberto Maggiore, Oriol Manuel, Anne Scemla, Francisco López-Medrano, et al.. Diagnosis and management of asymptomatic bacteriuria in kidney transplant recipients: a survey of current practice in Europe. Nephrology Dialysis Transplantation, 2018, 33 (9), pp.1661-1668. ⟨10.1093/ndt/gfy078⟩. ⟨hal-02121198⟩