Asymptomatic bacteriuria and urinary tract infections among renal allograft recipients.
OBJECTIVE
Bacteriuria is common among renal allograft recipients. It can be categorized into asymptomatic bacteriuria (ASB) and urinary tract infection (UTI). However, in medical literature, the classifications of bacteriuria are often not clear or ASB is also classified as a UTI. This contributes to difficulties in interpretation of the incidence and risk factors of these two entities. In this review, we describe the epidemiology, risk factors, management and the impact on renal allograft function of these two entities separately according to the recent literature.


RESULTS
Risk factors for ASB are not completely comparable to the risk factors of UTIs. Persistent ASB has been associated with development of acute rejection and allograft pyelonephritis. The available data suggest that treatment of ASB is not very effective. Prophylaxis with trimethoprim-sulfamethoxazole does not prevent UTIs such as allograft pyelonephritis. Blood stream infections and emphysematous allograft pyelonephritis are associated with renal allograft loss.


CONCLUSIONS
ASB is the most common manifestation of bacteriuria after renal transplantation. More effective interventions are needed to prevent bacteriuria. Renal allograft recipients with persistent ASB should be closely monitored since they could be at risk for developing not only UTIs, such as allograft pyelonephritis, but also acute rejection.
aDivision of Nephrology, Renal Transplant Unit bDivision of Infectious Diseases, Department of Internal Medicine, Academic Medical Center, University of Amsterdam, the Netherlands.
Ramandeep
R
Singh
Suzanne E
SE
Geerlings
Frederike J
FJ
Bemelman
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D001437:Bacteriuria / Q000097:blood* / Q000453:epidemiology; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D011704:Pyelonephritis / Q000097:blood* / Q000453:epidemiology / Q000276:immunology; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage; D014552:Urinary Tract Infections / Q000097:blood* / Q000453:epidemiology / Q000276:immunology
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination