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). Issue 3 (4th January 2021)

• Record Type: Journal Article
• Authors: Pierrotti, Ligia C.; Pérez‐Nadales, Elena; Fernández‐Ruiz, Mario; Gutiérrez‐Gutiérrez, Belén; Tan, Ban Hock; Carratalà, 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; Seminari, Elena M.; Valerio, Maricela; Gunseren, Filiz; Rana, Meenakshi; Mularoni, Alessandra; Martín‐Dávila, Pilar; van Delden, Christian; Hamiyet Demirkaya, Melike; Koçak Tufan, Zeliha; Loeches, Belén; Iyer, Ranganathan N.; Soldani, Fabio; Eriksson, Britt‐Marie; Pilmis, Benoît; Rizzi, Marco; Coussement, Julien; Clemente, Wanessa T.; Roilides, Emmanuel; Pascual, Álvaro; Martínez‐Martínez, Luis; Rodríguez‐Baño, Jesús; Torre‐Cisneros, Julian; Aguado, José María;
• Other Names: Kee Terence Yi Shern investigator.; Sabé Núria investigator.; Camoez Mariana investigator.; Domínguez María A investigator.; Koppel Fidi investigator.; Lora‐Tamayo Jaime investigator.; Lopez‐Soria Leyre investigator.; David‐Neto Elias investigator.; de Paula e Flávia Rossi Flávio Jota investigator.; Lepe Jose Antonio investigator.; Blanco Gabriel Bernal investigator.; Martín‐Gandul Cecilia investigator.; Balibrea Noelia investigator.; Franco Antonio investigator.; Avery Robin investigator.; Ostrander Darin investigator.; Dalla Gasperina Daniela investigator.; Rovelli Cristina investigator.; Natera Alejandra M investigator.; Recio‐Rufián Manuel investigator.; Guzmán‐Puche Julia investigator.; Leoni Cristina investigator.; Muñoz Patricia investigator.; Sánchez‐Carrillo Carlos investigator.; Lardo Sara investigator.; Altman Deena Rose investigator.; Fortún Jesús investigator.; Escudero Rosa investigator.; Gioia Francesca investigator.; Muller Nicolas J investigator.; Manuel Oriol investigator.; investigator.; Arslan Hande investigator.; Hasanoglu Imran investigator.; López Oliva Maria investigator.; Chiese Sheila investigator.; Salerno Nicola Duccio investigator.; Lortholary Olivier investigator.; Scemla Anne investigator.; Grazia Calvi Elisa investigator.; Dewispelaere Laurent investigator.; Mourão Paulo Henrique Orlandi investigator.; Pyrpasopoulou Athina investigator.; Romiopoulos Iordanis investigator.; Iosifidis Elias investigator.; Abdala Edson investigator.; Bodro Marta investigator.; Strabelli Tania Mara Varejão investigator.; Fariñas María Carmen investigator.; Lowman Warren investigator.; Falcone Marco investigator.; Kazak Esra investigator.; Tumbarello Mario investigator.; Lease Erika investigator.; Nestorova Nina investigator.;
• Is Part Of: Transplant infectious disease. Volume 23:Issue 3(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-01-04
• Subjects: bloodstream infection -- carbapenem‐sparing regimen -- extended‐spectrum β‐lactamase‐producing Enterobacterales -- kidney transplantation -- outcomes -- urinary tract infection; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.13520
• Languages: English
• ISSNs: 1398-2273

Abstract

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 (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/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 (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).