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

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URI: http://hdl.handle.net/10902/21966
ISSN: 1398-2273
ISSN: 1399-3062
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Autoría
Pierrotti, Ligia C.; Pérez Nadales, Elena; Fernández Ruiz, Mario; Gutiérrez Gutiérrez, Belén; Hock Tan, Ban; Carratalá Fernández, Jordi; Oriol, Isabel; Paul, Mical; Cohen Sinai, Noa; López Medrano, Francisco; San Juan, Rafael; Montejo, Miguel; Freire, Maristela P.; Cordero, Elisa; David, Miruna D.; Merino, Esperanza; Mehta Steinke, Seema; Grossi, Paolo A.; Cano, Ángela; [et al.]
Fecha
2021-06
Derechos
This is the pre-peer reviewed version of the following article: [Pierrotti, LC, Pérez-Nadales, E, Fernández-Ruiz, M, et al; Investigators from the REIPI/INCREMENT-SOT Group. Efficacy of ?-lactam/?-lactamase inhibitors to treat extended-spectrum beta-lactamase-producing Enterobacterales bacteremia secondary to urinary tract infection in kidney transplant recipients (INCREMENT-SOT Project). Transpl Infect Dis. 2021; 23:e13520. https://doi.org/10.1111/tid.13520], which has been published in final form at [https://doi.org/10.1111/tid.13520]. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.
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Transpl Infect Dis. 2021;23:e13520.
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Wiley
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Palabras clave
Kidney transplantation
Extended-spectrum β-lactamase-producing Enterobacterales 231 (ESBL-E)
Urinary tract infection (UTI
Bloodstream infection (BSI)
Outcomes
Carbapenem-sparing 232 regimen
Resumen/Abstract
Background: Whether active therapy with ?-lactam/?-lactamase inhibitors (BLBLI) is as affective as carbapenems for extended-spectrum ?-lactamase-producing Enterobacterales (ESBL-E) bloodstream infection (BSI) secondary to urinary tract infection (UTI) in kidney transplant recipients (KTRs) 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 was the 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/?L 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 (PS)-adjusted models revealed no significant impact of the choice of active therapy (carbapenem-containing vs any other regimen, BLBLI- vs 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).
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