Clinical Urinary Tract Infections in Kidney Transplant Recipients With Initially Asymptomatic Bacteriuria: A Single-Center Retrospective Cohort Study
Bibliographic record
Abstract
Rationale & Objective Management of asymptomatic bacteriuria in kidney transplant recipients remains uncertain. Our main objective was to evaluate whether patient- or episode-related factors could help identify episodes of asymptomatic bacteriuria associated with a higher risk of being followed by a symptomatic urinary tract infection. Study Design A single-center, retrospective cohort study. Settings & Participants Consecutive patients who received a kidney transplantation between January 1, 2008, and April 26, 2016, and experienced≥1 episode of asymptomatic bacteriuria during the first 3 years posttransplantation. Exposure Recipient age, sex, diabetes, donor type, retransplant, urological abnormalities, thymoglobulin for induction, time since transplant, presence of ureteral stent, prior acute rejection, leukocyturia, hematuria, urinary nitrites, bacterial strain, prior urinary tract infection, resistance to antibiotics, antibiotic treatment. Outcomes The primary outcome was the occurrence of symptomatic urinary tract infection. The secondary outcome was antibiotic treatment of asymptomatic bacteriuria. Analytical Approach A Cox regression survival analysis model accounting for recurrent events and a logistic regression model. Results From a cohort of 508 patients, we included 597 episodes of asymptomatic bacteriuria detected in 119 outpatients. Antibiotics were prescribed in 26% of these episodes. Overall, 56 (9%) of episodes were followed by a symptomatic urinary tract infection. Pretransplant diabetes (hazard ratio [HR], 4.28; 95% confidence intervals [CI], 2.40-7.61), leukocyturia or hematuria (HR, 2.24; 95% CI, 1.27-3.96), and the presence of a ureteral stent (HR, 3.40; 95% CI, 1.33-8.70) were associated with development of a clinical urinary tract infection in patients with asymptomatic bacteriuria. Limitations The small number of events limits complete multivariable adjustment. It also prevents us from drawing a definite conclusion about the importance of a number of independent variables as risk factors for the outcome. Conclusions The benefit of treating episodes of asymptomatic bacteriuria with high-risk characteristics should be investigated in future trials. Plain Language Summary Urine infections are very frequent in patients who have received a kidney transplant. Bacteria are sometimes found in the urine of patients who report no symptoms. This is called asymptomatic bacteriuria. Asymptomatic bacteriuria is a risk factor for having an overt symptomatic urine infection, but previous small studies did not show any benefit of treatment. However, this may be different if only patients with asymptomatic bacteriuria at high risk of developing an overt infection were treated. In this study, we identified 3 features that put patients with asymptomatic bacteriuria at higher risk of developing overt infections: diabetes, presence of a stent in the ureter, and white or red blood cells in the urine when bacteriuria is detected. Examining the benefit of screening and treatment of asymptomatic bacteriuria in patients with these high-risk features warrants further investigation.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".