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

L.C. Pierrotti, E. Pérez-Nadales, M. Fernández-Ruiz, B. Gutiérrez-Gutiérrez, B.H. Tan, J. Carratalà, I. Oriol, M. Paul, N. Cohen-Sinai, F. López-Medrano, R. San-Juan, M. Montejo, M.P. Freire, E. Cordero, M.D. David, E. Merino, S. Mehta Steinke, P.A. Grossi, Á. Cano, E.M. SeminariM. Valerio, F. Gunseren, M. Rana, A. Mularoni, P. Martín-Dávila, C. van Delden, M. Hamiyet Demirkaya, Z. Koçak Tufan, B. Loeches, R.N. Iyer, F. Soldani, B.-M. Eriksson, B. Pilmis, M. Rizzi, J. Coussement, W.T. Clemente, E. Roilides, Á. Pascual, L. Martínez-Martínez, J. Rodríguez-Baño, J. Torre-Cisneros, J.M. Aguado, Investigators from the REIPI/INCREMENT-SOT Group

Research output: Contribution to journalArticlepeer-review

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).

Original languageEnglish
Pages (from-to)e13520
JournalTranspl Infect Dis
Volume23
Issue number3
DOIs
Publication statusPublished - 2021

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