How are kidney infections treated?
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Treatment of Kidney Infections: Current Approaches and Challenges
Introduction to Kidney Infections
Kidney infections, also known as pyelonephritis, are serious conditions that require prompt and effective treatment to prevent complications such as sepsis and kidney damage. The treatment strategies for kidney infections, particularly in kidney transplant recipients (KTRs), are complex due to the risk of antibiotic resistance and the need to protect the transplanted organ.
Antibiotic Treatment for Kidney Infections
Fosfomycin-Trometamol as an Alternative
Fosfomycin-trometamol (FT) has emerged as a potential alternative for treating urinary tract infections (UTIs) in kidney transplant recipients. Studies have shown that FT can be effective as a last-resort oral treatment for lower UTIs and as a stepdown treatment for upper UTIs after initial intravenous antibiotics. Clinical cure rates were reported at 67% for lower UTIs and 80% for upper UTIs, although relapses and recurrences were noted in a significant number of cases.
Perioperative Fosfomycin Prophylaxis
Fosfomycin disodium has also been evaluated for perioperative prophylaxis in renal transplant recipients. A randomized clinical trial demonstrated that a single dose of fosfomycin significantly reduced the incidence of symptomatic UTIs during the first seven weeks post-transplantation, without increasing adverse events.
Challenges with Antibiotic Resistance
The increasing resistance to commonly used antibiotics such as trimethoprim-sulfamethoxazole, amoxicillin/clavulanic acid, and ciprofloxacin complicates the treatment of UTIs in KTRs. This resistance necessitates the exploration of alternative antibiotics and treatment strategies .
Non-Antibiotic Treatments
Phage Therapy
Phage therapy (PT) has been explored as an experimental treatment for chronic UTIs caused by multi-drug resistant bacteria. In a case study, a kidney transplant recipient with recurrent UTIs caused by ESBL-producing Klebsiella pneumoniae was treated with PT. The patient eventually recovered after nephrectomy and 29 days of PT, although the specific role of PT in controlling the infection remains unclear.
D-Mannose and Proanthocyanidins
D-Mannose, a simple sugar, and proanthocyanidins (PAC) have shown potential in preventing UTIs by inhibiting bacterial adhesion to the urothelium. However, a study found no significant impact of D-Mannose plus PAC compared to PAC alone in reducing UTI incidence in de-novo kidney transplant recipients.
Management of Asymptomatic Bacteriuria (ASB)
Antibiotic Treatment vs. No Treatment
The treatment of asymptomatic bacteriuria (ASB) in kidney transplant recipients is controversial. Multiple studies have shown that treating ASB with antibiotics does not reduce the incidence of symptomatic UTIs and may promote the emergence of antibiotic-resistant bacteria . Consequently, a screen-and-treat strategy for ASB is not recommended, as it does not provide significant benefits and increases antibiotic use .
Conclusion
The treatment of kidney infections, particularly in kidney transplant recipients, involves a careful balance between effective infection control and the prevention of antibiotic resistance. While fosfomycin shows promise as an alternative treatment, the role of non-antibiotic therapies like phage therapy and D-Mannose requires further investigation. Additionally, the management of ASB should be approached with caution, avoiding unnecessary antibiotic use to prevent resistance. Ongoing research and randomized controlled trials are essential to optimize treatment strategies and improve outcomes for patients with kidney infections.
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