TY - JOUR
T1 - 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)
AU - Investigators from the REIPI/INCREMENT-SOT Group
AU - Swiss Transplant Cohort Study (STCS)
AU - Pierrotti, Ligia C.
AU - Pérez-Nadales, Elena
AU - Fernández-Ruiz, Mario
AU - Gutiérrez-Gutiérrez, Belén
AU - Tan, Ban Hock
AU - Carratalà, Jordi
AU - Oriol, Isabel
AU - Paul, Mical
AU - Cohen-Sinai, Noa
AU - López-Medrano, Francisco
AU - San-Juan, Rafael
AU - Montejo, Miguel
AU - Freire, Maristela P.
AU - Cordero, Elisa
AU - David, Miruna D.
AU - Merino, Esperanza
AU - Mehta Steinke, Seema
AU - Grossi, Paolo A.
AU - Cano, Ángela
AU - Seminari, Elena M.
AU - Valerio, Maricela
AU - Gunseren, Filiz
AU - Rana, Meenakshi
AU - Mularoni, Alessandra
AU - Martín-Dávila, Pilar
AU - van Delden, Christian
AU - Hamiyet Demirkaya, Melike
AU - Koçak Tufan, Zeliha
AU - Loeches, Belén
AU - Iyer, Ranganathan N.
AU - Soldani, Fabio
AU - Eriksson, Britt Marie
AU - Pilmis, Benoît
AU - Rizzi, Marco
AU - Coussement, Julien
AU - Clemente, Wanessa T.
AU - Roilides, Emmanuel
AU - Pascual, Álvaro
AU - Martínez-Martínez, Luis
AU - Rodríguez-Baño, Jesús
AU - Torre-Cisneros, Julian
AU - Aguado, José María
AU - Kee, Terence Yi Shern
AU - Sabé, Núria
AU - Camoez, Mariana
AU - Domínguez, María A.
AU - Koppel, Fidi
AU - Lora-Tamayo, Jaime
AU - Lopez-Soria, Leyre
AU - Altman, Deena Rose
N1 - Publisher Copyright:
© 2020 Wiley Periodicals LLC
PY - 2021/6
Y1 - 2021/6
N2 - 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).
AB - 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).
KW - bloodstream infection
KW - carbapenem-sparing regimen
KW - extended-spectrum β-lactamase-producing Enterobacterales
KW - kidney transplantation
KW - outcomes
KW - urinary tract infection
UR - http://www.scopus.com/inward/record.url?scp=85107769216&partnerID=8YFLogxK
U2 - 10.1111/tid.13520
DO - 10.1111/tid.13520
M3 - Article
C2 - 33222379
AN - SCOPUS:85107769216
SN - 1398-2273
VL - 23
JO - Transplant Infectious Disease
JF - Transplant Infectious Disease
IS - 3
M1 - e13520
ER -