RT Journal Article
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).
A1 Pierrotti, Ligia C
A1 Perez-Nadales, Elena
A1 Fernandez-Ruiz, Mario
A1 Gutierrez-Gutierrez, Belen
A1 Tan, Ban Hock
A1 Carratala, Jordi
A1 Oriol, Isabel
A1 Paul, Mical
A1 Cohen-Sinai, Noa
A1 Lopez-Medrano, Francisco
A1 San-Juan, Rafael
A1 Montejo, Miguel
A1 Freire, Maristela P
A1 Cordero, Elisa
A1 David, Miruna D
A1 Merino, Esperanza
A1 Mehta Steinke, Seema
A1 Grossi, Paolo A
A1 Cano, Angela
A1 Seminari, Elena M
A1 Valerio, Maricela
A1 Gunseren, Filiz
A1 Rana, Meenakshi
A1 Mularoni, Alessandra
A1 Martin-Davila, Pilar
A1 van Delden, Christian
A1 Hamiyet Demirkaya, Melike
A1 Koçak Tufan, Zeliha
A1 Loeches, Belén
A1 Iyer, Ranganathan N
A1 Soldani, Fabio
A1 Eriksson, Britt-Marie
A1 Pilmis, Benoît
A1 Rizzi, Marco
A1 Coussement, Julien
A1 Clemente, Wanessa T
A1 Roilides, Emmanuel
A1 Pascual, Alvaro
A1 Martinez-Martinez, Luis
A1 Rodriguez-Baño, Jesus
A1 Torre-Cisneros, Julian
A1 Aguado, Jose Maria
K1 Bloodstream infection
K1 Carbapenem-sparing regimen
K1 Extended-spectrum β-lactamase-producing Enterobacterales
K1 Kidney transplantation
K1 Outcomes
K1 Urinary tract infection
AB 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. 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. 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. 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.
PB Wiley
YR 2020
FD 2020-11-07
LK http://hdl.handle.net/10668/16643
UL http://hdl.handle.net/10668/16643
LA en
NO Pierrotti LC, Pérez-Nadales E, Fernández-Ruiz M, Gutiérrez-Gutiérrez B, Tan BH, Carratalà J, et al. 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). Transpl Infect Dis. 2021 Jun;23(3):e13520
DS RISalud
RD Apr 13, 2025