Efficacy of β-lactam/β-lactamase inhibitors to treat extended-spectrum beta-lactamase-producing Enterobacterales bacteremia secondary to urinary tract infection in kidney transplant recipients (INCREMENT-SOT Project).

Pierrotti, Ligia Camera and Pérez-Nadales, Elena and Fernández-Ruiz, Mario and Gutiérrez-Gutiérrez, Belén and Hock Tan, Ban and Carratalà, Jordi and Oriol, Isabel and Paul, Mical and Cohen-Sinai, Noa and López-Medrano, Francisco and San-Juan, Rafael and Montejo, Miguel and Freire, Maristela Pinheiro and Cordero, Elisa and David, Miruna D and Merino, Esperanza and Mehta Steinke, Seema and Grossi, Paolo Antonio and Cano, Ángela and Seminari, Elena Maria and Valerio, Maricela and Gunseren, Filiz and Rana, Meenakshi and Mularoni, Alessandra and Martín-Dávila, Pilar and van Delden, Christian and Hamiyet Demirkaya, Melie and Koçak Tufan, Zeliha and Loeches, Belén and Iyer, Ranganathan N and Soldani, Fabio and Eriksson, Britt-Marie and Pilmis, Benoît and Rizzi, Marco and Coussement, Julien and Clemente, Wanessa Trindade and Roilides, Emmanuel and Pascual, Álvaro and Martínez-Martínez, Luis and Rodríguez-Baño, Jesús and Torre-Cisneros, Julián and Aguado, José María (2020) Efficacy of β-lactam/β-lactamase inhibitors to treat extended-spectrum beta-lactamase-producing Enterobacterales bacteremia secondary to urinary tract infection in kidney transplant recipients (INCREMENT-SOT Project). Transplant infectious disease : an official journal of the Transplantation Society. e13520. ISSN 1399-3062.

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Abstract

BACKGROUND

Whether active therapy with β-lactam/β-lactamase inhibitors (BLBLI) is as affective as carbapenems for extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) bloodstream infection (BSI) secondary to urinary tract infection (UTI) in kidney transplant recipients (KTR) remains unclear.

METHODS

We retrospectively evaluated 306 KTR admitted to 30 centers from January 2014 to October 2016. Therapeutic failure (lack of cure or clinical improvement and/or death from any cause) at days 7 and 30 from ESBL-E BSI onset were primary and secondary study outcomes, respectively.

RESULTS

Therapeutic failure at days 7 and 30 occurred in 8.2% (25/306) and 13.4% (41/306) of patients. Hospital-acquired BSI (adjusted OR [aOR]: 4.10; 95% confidence interval [CI]: 1.50-11.20) and Pitt score (aOR: 1.47; 95% CI: 1.21-1.77) were independently associated with therapeutic failure at day 7. Age-adjusted Charlson Index (aOR: 1.25; 95% CI: 1.05-1.48), Pitt score (aOR: 1.72; 95% CI: 1.35-2.17) and lymphocyte count ≤500 cells/μL at presentation (aOR: 3.16; 95% CI: 1.42-7.06) predicted therapeutic failure at day 30. Carbapenem monotherapy (68.6%, primarily meropenem) was the most frequent active therapy, followed by BLBLI monotherapy (10.8%, mostly piperacillin-tazobactam). Propensity score-adjusted models revealed no significant impact of the choice of active therapy (carbapenem-containing versus any other regimen, BLBLI- versus carbapenem-based monotherapy) within the first 72 hours on any of the study outcomes.

CONCLUSIONS

Our data suggest that active therapy based on BLBLI may be as effective as carbapenem-containing regimens for ESBL-E BSI secondary to UTI in the specific population of KTR. Potential residual confounding and unpowered sample size cannot be excluded (ClinicalTrials.gov identifier: NCT02852902).

Item Type: Article
Subjects: WJ Urogenital system. Urology
Divisions: Clinical Support > Infection Control
Emergency Services > Renal
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Depositing User: Mr Philip O'Reilly
Date Deposited: 27 Nov 2020 15:16
Last Modified: 27 Nov 2020 15:16
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3732

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