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
,
Georges Mourad
(40)
,
Thomas Mueller
(41)
,
Patricia Muñoz
(42)
,
Alexander Nabokow
,
Maarten Naesens
(43)
,
Maria Nikodimopoulou
,
Rainer Oberbauer
(44)
,
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
(45)
,
Giovanni Piotti
(46)
,
Lissa Pipeleers
,
Christos Pleros
,
Joyce Popoola
,
Renzo Pretagostini
,
Erasmia Psimenou
,
Josep Puig
(47)
,
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
(48)
,
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
(49)
,
Georgios Spanos
,
Jürg Steiger
(50)
,
Barbara Suwelack
,
Eleni Theodoropoulou
,
Eric Thervet
(37)
,
Stefan Thorban
,
Giuliana Tognarelli
,
Yasmina Tournay
,
Leïla Tricot
(51)
,
Patrizia Tulissi
,
Henri Vacher-Coponat
(52)
,
Maricela Valerio
,
W van Der Meijden
,
Henk van Hamersvelt
,
Steven van Laecke
(53)
,
Alain Vandivinit
,
Raymond Vanholder
(54)
,
Massimiliano Veroux
,
Ondrej Viklicky
(55)
,
Emanuela Vigo
,
Claudio Viscoli
(56)
,
W Watschinger
,
W Weekers
,
W Welberry Smith
,
W Martin
,
Nereida Zeneli
,
Angelos Zervos
,
Lada Zibar
,
Julien Zuber
(57)
,
Bianca Zukunft
1
Department Infections Diseases
2 Azienda Ospedaliero-Universitaria di Parma
3 CHUV - Centre Hospitalier Universitaire Vaudois [Lausanne]
4 Réseau CENTAURE
5 CHU Pitié-Salpêtrière [AP-HP]
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 CHU Tenon [AP-HP]
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 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
41 Department of Laboratory Medicine
42 Clinical Microbiology and Infectious Diseases Department
43 University Hospitals Leuven [Leuven]
44 Department of Internal Medicine III
45 Service de rhumatologie
46 Kidney and Pancreas Transplantation
47 Department d'enginyeria quimica agraria i tecnologia agroalimentaria
48 Néphrologie Transplantation
49 Section of Microbiology [Copenhagen]
50 University Hospital Basel [Basel]
51 Service Néphrologie Transplantation Rénale
52 Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM]
53 Renal Division
54 Nephrology Section [Ghent]
55 Dept. of Nephrology
56 Division of Infectious Diseases
57 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
2 Azienda Ospedaliero-Universitaria di Parma
3 CHUV - Centre Hospitalier Universitaire Vaudois [Lausanne]
4 Réseau CENTAURE
5 CHU Pitié-Salpêtrière [AP-HP]
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 CHU Tenon [AP-HP]
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 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
41 Department of Laboratory Medicine
42 Clinical Microbiology and Infectious Diseases Department
43 University Hospitals Leuven [Leuven]
44 Department of Internal Medicine III
45 Service de rhumatologie
46 Kidney and Pancreas Transplantation
47 Department d'enginyeria quimica agraria i tecnologia agroalimentaria
48 Néphrologie Transplantation
49 Section of Microbiology [Copenhagen]
50 University Hospital Basel [Basel]
51 Service Néphrologie Transplantation Rénale
52 Centre de néphrologie et transplantation rénale [Hôpital de la Conception - APHM]
53 Renal Division
54 Nephrology Section [Ghent]
55 Dept. of Nephrology
56 Division of Infectious Diseases
57 AP-HP - Assistance publique - Hôpitaux de Paris (AP-HP)
Francisco López-Medrano
- Function : Author
Evi Nagler
- Function : Author
José María Aguado
- Function : Author
Daniel Abramowicz
- Function : Author
Brigitte Adams
- Function : Author
Caroline Agnelli
- Function : Author
Hamdi Akan
- Function : Author
Lucile Amrouche
- Function : Author
Amado Andrés
- Function : Author
Dany Anglicheau
- Function : Author
- PersonId : 773300
- ORCID : 0000-0001-5793-6174
Paul Arnouts
- Function : Author
Marije Baas
- Function : Author
Cristian Balgradean
- Function : Author
Bert Bammens
- Function : Author
Yuri Battaglia
- Function : Author
Thomas Baudoux
- Function : Author
Bert Berto
- Function : Author
Isabelle Binet
- Function : Author
Claus Bistrup
- Function : Author
Renzo Bonofiglio
- Function : Author
Jean-Louis Bosmans
- Function : Author
Yassine Bouatou
- Function : Author
Philippe Braconnier
- Function : Author
Edwin Bredewold
- Function : Author
Nilufer Broeders
- Function : Author
Philippe Brunet
- Function : Author
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Stéphane Burtey
- Function : Author
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Andrea Buscaroli
- Function : Author
Stefan Büttner
- Function : Author
Catherine Byrne
- Function : Author
Rossana Caldara
- Function : Author
Concetta Catalano
- Function : Author
Guilhem Cavaille
- Function : Author
Lionel Couzi
- Function : Author
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- IdRef : 076993671
Marta Crespo
- Function : Author
Sunil Daga
- Function : Author
Ivana Dedinska
- Function : Author
Paul Devine
- Function : Author
Michael Dickenmann
- Function : Author
Max Dratwa
- Function : Author
Lubos Drgona
- Function : Author
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- ORCID : 0000-0002-5089-3201
Magdalena Durlik
- Function : Author
Maria Francesca Egidi
- Function : Author
Pedro Errasti
- Function : Author
María Carmen Fariñas
- Function : Author
Thomas Fehr
- Function : Author
Paraskevi Founta
- Function : Author
Konstantinos Fourtounas
- Function : Author
Eleni Frangou
- Function : Author
Luc Frimat
- Function : Author
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Luc Furian
- Function : Author
Maria Garjau
- Function : Author
Philippe Gatault
- Function : Author
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- IdRef : 16936383X
Colin Geddes
- Function : Author
Paul Gerlinger
- Function : Author
Eric Gheuens
- Function : Author
Lidia Ghisdal
- Function : Author
Paul Gibbs
- Function : Author
Magali Giral
- Function : Author
- PersonId : 944333
Athina Gompou
- Function : Author
Paolo Antonio Grossi
- Function : Author
Gabriele Guglielmetti
- Function : Author
Luis Guirado
- Function : Author
Karine Hadaya
- Function : Author
Mark Helbert
- Function : Author
Rachel Hellemans
- Function : Author
Katharina Heller
- Function : Author
Manu Henckes
- Function : Author
Domingo Hernandez
- Function : Author
Alexandre Hertig
- Function : Author
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Luuk Hilbrands
- Function : Author
Rachel Hilton
- Function : Author
Juan Pablo Horcajada
- Function : Author
Jean-Michel Hougardy
- Function : Author
Alma Idrizi
- Function : Author
Khalid Ismaili
- Function : Author
Carlos Jiménez
- Function : Author
- PersonId : 937379
Noemie Jourde-Chiche
- Function : Author
- PersonId : 1064169
Nassim Kamar
- Function : Author
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Hannah Kaminski
- Function : Author
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Julia Kanter
- Function : Author
Alexandre Karras
- Function : Author
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- IdRef : 077765036
Delphine Kemlin
- Function : Author
Petar Kes
- Function : Author
Mireille Kianda
- Function : Author
Maria Klinger
- Function : Author
Irene Koneth
- Function : Author
Anita Krrashi
- Function : Author
Anne Langlois
- Function : Author
Ricardo Lauzurica
- Function : Author
Alain Le Moine
- Function : Author
Anne Lemy
- Function : Author
Oscar Len
- Function : Author
Vassilios Liakopoulos
- Function : Author
Monika Lichodziejewska-Niemierko
- Function : Author
Maria Yague
- Function : Author
Kai Lopau
- Function : Author
Philippe Madhoun
- Function : Author
Maria Magott-Procelewska
- Function : Author
Shafi Malik
- Function : Author
Anna Manonelles Montero
- Function : Author
Marc Marchini
- Function : Author
Alessandra Marega
- Function : Author
Maria Mariat
- Function : Author
Mark Mark
- Function : Author
Pierre-Yves Martin
- Function : Author
Leyre Martín
- Function : Author
Paloma Leticia Martín
- Function : Author
Annick Massart
- Function : Author
Marie Matignon
- Function : Author
- PersonId : 760751
- ORCID : 0000-0001-7704-427X
Stéphane Maurel
- Function : Author
Auxiliadora Mazuecos
- Function : Author
Christina Melexopoulou
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Edoardo Melilli
- Function : Author
- PersonId : 795008
- ORCID : 0000-0001-6965-3745
Esperanza Merino
- Function : Author
Enisa Mesic
- Function : Author
Magdalena Michalak
- Function : Author
Enrico Minetti
- Function : Author
Grigorios Miserlis
- Function : Author
Miguel Montejo
- Function : Author
Diego Moriconi
- Function : Author
Clément Mottola
- Function : Author
Thomas Mueller
- Function : Author
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- ORCID : 0000-0003-1862-7357
Alexander Nabokow
- Function : Author
Maarten Naesens
- Function : Author
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- ORCID : 0000-0002-5625-0792
Maria Nikodimopoulou
- Function : Author
María Olmedo
- Function : Author
Jonathon Olsburgh
- Function : Author
Gabriel Oniscu
- Function : Author
Lara Aygen Øzbay
- Function : Author
Alessandra Palmisano
- Function : Author
Aikaterini Papagianni
- Function : Author
Mario Papasotiriou
- Function : Author
Angelica Parodi
- Function : Author
Rob Parry
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Julio Pascual
- Function : Author
Isabel Pérez Flores
- Function : Author
María Pérez-Sáez
- Function : Author
Licia Peruzzi
- Function : Author
Paul Phelan
- Function : Author
Lissa Pipeleers
- Function : Author
Christos Pleros
- Function : Author
Joyce Popoola
- Function : Author
Renzo Pretagostini
- Function : Author
Erasmia Psimenou
- Function : Author
Silvie Rajnochova Bloudickova
- Function : Author
Irena Rambabova Bushljetikj
- Function : Author
Marina Ratkovic
- Function : Author
Dolores Redondo
- Function : Author
Tomas Reischig
- Function : Author
Luis Ferrero
- Function : Author
Merita Rroji
- Function : Author
Przemyslaw Rutkowski
- Function : Author
Alicja Rydzewska-Rosolowska
- Function : Author
Núria Sabé
- Function : Author
Bernd Salzberger
- Function : Author
Rafael San-Juan
- Function : Author
Beatriz Sánchez Sobrino
- Function : Author
Silvio Sandrini
- Function : Author
Lídia Santos
- Function : Author
Roxana Sava
- Function : Author
Stefan Schaub
- Function : Author
Betoul Schvartz
- Function : Author
Urban Sester
- Function : Author
Jose Tiago Silva
- Function : Author
Renaud Snanoudj
- Function : Author
- PersonId : 770323
- ORCID : 0000-0002-6657-6235
- IdRef : 061671010
Danio Somenzi
- Function : Author
Georgios Spanos
- Function : Author
Barbara Suwelack
- Function : Author
Eleni Theodoropoulou
- Function : Author
Stefan Thorban
- Function : Author
Giuliana Tognarelli
- Function : Author
Yasmina Tournay
- Function : Author
Patrizia Tulissi
- Function : Author
Henri Vacher-Coponat
- Function : Author
- PersonId : 935929
Maricela Valerio
- Function : Author
W van Der Meijden
- Function : Author
Henk van Hamersvelt
- Function : Author
Alain Vandivinit
- Function : Author
Raymond Vanholder
- Function : Author
- PersonId : 768115
- ORCID : 0000-0003-2633-1636
Massimiliano Veroux
- Function : Author
Emanuela Vigo
- Function : Author
W Watschinger
- Function : Author
W Weekers
- Function : Author
W Welberry Smith
- Function : Author
W Martin
- Function : Author
Nereida Zeneli
- Function : Author
Angelos Zervos
- Function : Author
Lada Zibar
- Function : Author
Julien Zuber
- Function : Author
- PersonId : 760868
- ORCID : 0000-0001-6741-9330
- IdRef : 070677654
Bianca Zukunft
- Function : Author
Abstract
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.