Background. Renal transplant recipients (RTR) with asymptomatic bacteriuria (AB) are often treated with antibiotics. This could lead to complications related to antibiotic treatment including Clostridium difficile infection (CDI). Outcomes of untreated AB in RTR are unknown.

Methods. This was a retrospective analysis of RTR transplanted between April 2011 and March 2014. RTR with at least one AB episode in the first year post-transplant were included. Only the first AB episodes were analyzed. AB was defined as positive urine culture ≥10⁴ cfu/mL in the absence of clinical symptoms. The primary outcome was occurrence of pyelonephritis, defined as bacteriuria with clinical symptoms and allograft tenderness. Subsequent symptomatic urinary tract infections (UTI), allograft rejection, and CDI were also analyzed. The Chi-square test was used with a p-value of <0.05 considered significant.

Results. A total of 214 RTR were identified; 36% (n=78) had at least one AB episode. Of these 78 AB episodes, 60% (n=47) were untreated. Common etiologies of AB episodes are shown in Table 1. The differences in 30-day rate of UTI (17% vs. 3%, p=0.13), 30-day pyelonephritis (2% vs. 0%, p=1), 1-year UTI (45% vs. 32%, p=0.39) and 1-year pyelonephritis (9% vs. 13% p=0.8)in the untreated vs. treated groups were not statistically significant. Rates of allograft rejection at 1-year (4% vs. 13%, p=0.33) and CDI at 1-year (4% vs 0%, p=ns) were also not different in the untreated vs. treated groups.

Conclusion. AB is common in RTR during the first year post-transplant. Although not statistically significant, 30-day UTI and pyelonephritis rates appear to be higher among patients who did not receive treatment for AB.

CITATION INFORMATION: Davis W, Lee R.-A, Daniels L, Todd S, True K, Chong P. Outcomes of Untreated Asymptomatic Bacteriuria in Renal Transplant Recipients: A Single-Center Experience. Am J Transplant. 2016;16 (suppl 3).

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