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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).
Journal article

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 LC Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medicah School, São Paulo, Brazil.
  • Pérez-Nadales E Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Fernández-Ruiz M Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Gutiérrez-Gutiérrez B Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Hock Tan B Department of Infectious Diseases, Singapore General Hospital, Singapore.
  • Carratalà J Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Oriol I Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Paul M Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel.
  • Cohen-Sinai N Technion - Israel Institute of Technology, Haifa, Israel.
  • López-Medrano F Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • San-Juan R Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Montejo M Infectious Diseases Unit, Cruces University Hospital, Bilbao, Spain.
  • Freire MP Working Committee for Hospital Epidemiology and Infection Control, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
  • Cordero E Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • David MD University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.
  • Merino E Unit of Infectious Diseases, General University Hospital of Alicante, ISABIAl, Alicante, Spain.
  • Mehta Steinke S Johns Hopkins University, School of Medicine, Baltimore, USA.
  • Grossi PA Department of Medicine and Surgery, University of Insubria, Varese, Italy.
  • Cano Á Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Seminari EM Infectious Diseases Clici, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Valerio M Clinical Microbiology and Infectious Disease Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  • Gunseren F Department of Infectious Diseases and Clinical Microbiology, Akdeniz University, Faculty of Medicine, Antalya, Turkey.
  • Rana M Icahn School of Medicine at Mount Sinai, New York, USA.
  • Mularoni A IRCCS-ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo, Italy.
  • Martín-Dávila P Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • van Delden C Unit for Transplant Infectious Diseases, University Hospitals of Geneva, Geneva, Switzerland.
  • Hamiyet Demirkaya M Başkent University School of Medicine, Ankara, Turkey.
  • Koçak Tufan Z Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim, Beyazit University, Ankara, Turkey.
  • Loeches B Infectious Diseases Unit, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain.
  • Iyer RN Clinical Microbiology ID & Infection control, Global Hospitals, Hyderabab, India.
  • Soldani F Division of Infectious Diseases, Department of Medicine, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
  • Eriksson BM Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
  • Pilmis B Paris Descartes University, Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France.
  • Rizzi M Infectious Diseases Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
  • Coussement J Division of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
  • Clemente WT Faculty of Medicine, Federal University of Minas Gerais (UFMG), Brazil, Digestive Transplant Service, Liver Transplant Group, Instituto Alfa de Gastroenterologia do Hospital das Clínicas, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.
  • Roilides E Infectious Diseases Unit and 3rd, Department of Pediatrics, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece.
  • Pascual Á Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Martínez-Martínez L Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Rodríguez-Baño J Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Torre-Cisneros J Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
  • Aguado JM Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
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  • 2020-11-22
Published in:
  • Transplant infectious disease : an official journal of the Transplantation Society. - 2020
bloodstream infection (BSI)
carbapenem-sparing regimen
extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E)
kidney transplantation
outcomes
urinary tract infection (UTI)
English 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).
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/249819
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