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Benefits and Harms of Treatment of Asymptomatic Bacteriuria: A Systematic Review and Meta-analysis by the European Association of Urology Urological Infection Guidelines Panel
European Urology ( IF 23.4 ) Pub Date : 2017-07-25 , DOI: 10.1016/j.eururo.2017.07.014
Bela Köves , Tommaso Cai , Rajan Veeratterapillay , Robert Pickard , Thomas Seisen , Thomas B. Lam , Cathy Yuhong Yuan , Franck Bruyere , Florian Wagenlehner , Riccardo Bartoletti , Suzanne E. Geerlings , Adrian Pilatz , Benjamin Pradere , Fabian Hofmann , Gernot Bonkat , Björn Wullt

People with asymptomatic bacteriuria (ABU) are often unnecessarily treated with antibiotics risking adverse effects and antimicrobial resistance. We performed a systematic review to determine any benefits and harms of treating ABU in particular patient groups. Relevant databases were searched and eligible trials were assessed for risk-of-bias and Grading of Recommendations, Assessment, Development and Education quality. Where possible, a meta-analysis of extracted data was performed or a narrative synthesis of the evidence was presented. After screening 3626 articles, 50 studies involving 7088 patients were included. Overall, quality of evidence ranged from very low to low. There was no evidence of benefit for patients with no risk factors, patients with diabetes mellitus, postmenopausal women, elderly institutionalised patients, patients with renal transplants, or patients prior to joint replacement, and treatment was harmful for patients with recurrent urinary tract infection (UTI). Treatment of ABU resulted in a lower risk of postoperative UTI after transurethral resection surgery. In pregnant women, we found evidence that treatment of ABU decreased risk of symptomatic UTI, low birthweight, and preterm delivery. ABU should be treated prior to transurethral resection surgery. In addition, current evidence also suggests that ABU treatment is required in pregnant women, although the results of a recent trial have challenged this view.

Patient summary

We reviewed available scientific studies to see if people with bacteria in their urine but without symptoms of urinary tract infection should be treated with antibiotics to eliminate bacteria. For most people, treatment was not beneficial and may be harmful. Antibiotic treatment did appear to benefit women in pregnancy and those about to undergo urological surgery.



中文翻译:

无症状细菌性尿道炎的益处和危害:欧洲泌尿外科协会泌尿外科感染指南小组的系统评价和荟萃分析

无症状菌尿症(ABU)的人经常不必要地接受具有不良反应和抗微生物药性的抗生素治疗。我们进行了系统的评估,以确定在特定患者群体中治疗ABU的任何利弊。搜索相关数据库,评估合格的试验的偏倚风险,以及建议的等级,评估,发展和教育质量。在可能的情况下,对提取的数据进行荟萃分析,或者对证据进行叙述性综合。在筛选了3626篇文章之后,纳入了涉及7088例患者的50项研究。总体而言,证据质量的范围从非常低到很低。没有证据表明没有危险因素的患者,糖尿病患者,绝经后妇女,老年住院患者,肾移植患者或关节置换术之前的患者,治疗对复发性尿路感染(UTI)的患者有害。经尿道切除手术后,ABU的治疗降低了术后泌尿道感染的风险。在孕妇中,我们发现有证据表明ABU治疗可降低症状性UTI,低出生体重和早产的风险。经尿道切除术前应治疗ABU。此外,尽管最近的一项试验结果对这一观点提出了挑战,但目前的证据还表明,孕妇需要进行ABU治疗。在孕妇中,我们发现有证据表明ABU治疗可降低症状性UTI,低出生体重和早产的风险。经尿道切除术前应治疗ABU。此外,尽管最近的一项试验结果对这一观点提出了挑战,但目前的证据还表明,孕妇需要进行ABU治疗。在孕妇中,我们发现有证据表明ABU治疗可降低症状性UTI,低出生体重和早产的风险。经尿道切除术前应治疗ABU。此外,尽管最近的一项试验结果对这一观点提出了挑战,但目前的证据还表明,孕妇需要进行ABU治疗。

病人总结

我们回顾了现有的科学研究,以了解尿液中有细菌但无尿路感染症状的人是否应该用抗生素治疗以消除细菌。对于大多数人来说,治疗无益,可能有害。抗生素治疗确实使孕妇和即将进行泌尿外科手术的妇女受益。

更新日期:2017-07-25
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