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Rau M, Santelli A, Martí S, Díaz MI, Sabé N, Fiol M, Riera L, Etcheverry B, Codina S, Coloma A, Carreras-Salinas A, Ardanuy C, Cruzado JM, Melilli E. Randomized clinical trial of non-antibiotic prophylaxis with d-Mannose plus Proanthocyanidins vs. Proanthocyanidins alone for urinary tract infections and asymptomatic bacteriuria in de novo kidney transplant recipients: The Manotras study. Nefrologia 2024:S2013-2514(24)00053-1. [PMID: 38637262 DOI: 10.1016/j.nefroe.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/30/2023] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Studies analyzing non-antibiotic alternatives in kidney transplant UTI's are lacking. d-Mannose, a simple sugar, inhibits bacterial attachment to the urothelium, as does Proanthocyanidins; both could act as a synergic strategy preventing UTI; nonetheless their efficacy and safety have not been evaluated in kidney transplant population yet. METHODS This is a pilot prospective, double-blind randomized trial. Sixty de novo kidney transplant recipients were randomized (1:1) to receive a prophylactic strategy based on a 24-h prolonged release formulation of d-Mannose plus Proanthocyanidins vs. Proanthocyanidins (PAC) alone. The supplements were taken for the first 3 months after kidney transplant and then followed up for 3 months as well. The main objective of the study was to search if the addition of Mannose to PAC alone reduced the incidence of UTI and/or asymptomatic bacteriuria in the first 6 months post-transplantation. RESULTS 27% of patients experienced one UTI episode (cystitis or pyelonephritis) while asymptomatic bacteriuria was very common (57%). Incidences according UTI type or AB were: 7% vs. 4% for cystitis episode (p 0.3), 4% vs. 5% for pyelonephritis (p 0.5) and 17% vs. 14% for asymptomatic bacteriuria (p 0.4) for patients in the Mannose+PAC group vs. PAC group respectively. The most frequent bacteria isolated in both groups was Escherichia coli (28% of all episodes), UTI or AB due to E. coli was not different according to study group (30% vs. 23% for Mannose+PAC vs. PAC alone p 0.37). CONCLUSIONS Non-antibiotic therapy is an unmet need to prevent UTI after kidney transplantation; however, the use of d-Mannose plus PAC does not seem capable to prevent it.
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Affiliation(s)
- Melissa Rau
- Nephrology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain
| | - Adrian Santelli
- Nephrology Department, Clínicas Hospital, Montevideo, Uruguay
| | - Sara Martí
- Microbiology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Biomedical Research Institute (IDIBELL), Duran i Reynalds Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - María Isabel Díaz
- Nephrology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Sabé
- Infectology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain
| | - María Fiol
- Urology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Luis Riera
- Urology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Begoña Etcheverry
- Urology Department, Bellvitge University Hospital, Hospitalet de Llobregat, Barcelona, Spain
| | - Sergi Codina
- Nephrology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Biomedical Research Institute (IDIBELL), Duran i Reynalds Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain
| | - Ana Coloma
- Nephrology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Biomedical Research Institute (IDIBELL), Duran i Reynalds Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain
| | - Anna Carreras-Salinas
- Microbiology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain
| | - Carmen Ardanuy
- Microbiology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Biomedical Research Institute (IDIBELL), Duran i Reynalds Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08907 L'Hospitalet de Llobregat, Barcelona, Spain; Research Network for Respiratory Diseases (CIBERES), ISCIII, Madrid, Spain
| | - Josep M Cruzado
- Nephrology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Biomedical Research Institute (IDIBELL), Duran i Reynalds Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Edoardo Melilli
- Nephrology Department, Bellvitge University Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain; Biomedical Research Institute (IDIBELL), Duran i Reynalds Hospital, 08907 Hospitalet de Llobregat, Barcelona, Spain.
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de Cueto M, Aliaga L, Alós JI, Canut A, Los-Arcos I, Martínez JA, Mensa J, Pintado V, Rodriguez-Pardo D, Yuste JR, Pigrau C. Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC). Enferm Infecc Microbiol Clin 2016; 35:314-320. [PMID: 28017477 DOI: 10.1016/j.eimc.2016.11.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
Most urinary tract infections (UTI) are uncomplicated infections occurring in young women. An extensive evaluation is not required in the majority of cases, and they can be safely managed as outpatients with oral antibiotics. Escherichia coli is by far the most common uropathogen, accounting for >80% of all cases. Other major clinical problems associated with UTI include asymptomatic bacteriuria, and patients with complicated UTI. Complicated UTIs are a heterogeneous group associated with conditions that increase the risk of acquiring infection or treatment failure. Distinguishing between complicated and uncomplicated UTI is important, as it influences the initial evaluation, choice, and duration of antimicrobial therapy. Diagnosis is especially challenging in the elderly and in patients with in-dwelling catheters. The increasing prevalence of resistant uropathogens, including extended-spectrum β-lactamases and carbapenemase-producing Enterobacteriaceae, and other multidrug-resistant Gram-negative organisms further compromises treatment of both complicated and uncomplicated UTIs. The aim of these Clinical Guidelines is to provide a set of recommendations for improving the diagnosis and treatment of UTI.
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Affiliation(s)
- Marina de Cueto
- Unidad Clinica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocio, Sevilla, Spain
| | - Luis Aliaga
- Unidad de Gestión Clínica de Medicina Interna, Hospital Universitario Unificado de Granada, Granada, Spain
| | - Juan-Ignacio Alós
- Servicio de Microbiología, Hospital Universitario de Getafe, Getafe, Spain
| | - Andres Canut
- Servicio de Microbiología, Hospital Universitario de Álava, Vitoria-Gasteiz, Spain
| | - Ibai Los-Arcos
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | | | - Jose Mensa
- Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Vicente Pintado
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
| | - Dolors Rodriguez-Pardo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Jose Ramon Yuste
- Área de Enfermedades Infecciosas, Clinica Universidad de Navarra, Pamplona, Spain
| | - Carles Pigrau
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
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