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

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 un...

Descripción completa

Detalles Bibliográficos
Autores: Pierrotti, L. C, Pérez-Nadales, E., Fernández-Ruiz, M., Gutiérrez Gutiérrez, Belén, Tan, B. H., Carratalà, J., Cordero Matia, María Elisa, Pascual Hernández, Álvaro, Rodríguez-Baño, Jesús, Aguado, J. M.
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Universidad de Sevilla (US)
Repositorio:idUS. Depósito de Investigación de la Universidad de Sevilla
OAI Identifier:oai:idus.us.es:11441/137493
Acceso en línea:https://hdl.handle.net/11441/137493
https://doi.org/10.1111/tid.13520
Access Level:acceso abierto
Palabra clave:Bloodstream infection
Carbapenem-sparing regimen
Extended-spectrum β-lactamase-producing Enterobacterales
Outcomes
Urinary tract infection
Kidney transplantation
id ES_b911b88d0162fc224924fc6b4bf0a204
oai_identifier_str oai:idus.us.es:11441/137493
network_acronym_str ES
network_name_str España
repository_id_str
spelling Efficacy of β-lactam/β-lactamase inhibitors to treat extended-spectrum beta-lactamase-producing Enterobacterales bacteremia secondary to urinary tract infection in kidney transplant recipientsPierrotti, L. CPérez-Nadales, E.Fernández-Ruiz, M.Gutiérrez Gutiérrez, BelénTan, B. H.Carratalà, J.Cordero Matia, María ElisaPascual Hernández, ÁlvaroRodríguez-Baño, JesúsAguado, J. M.Bloodstream infectionCarbapenem-sparing regimenExtended-spectrum β-lactamase-producing EnterobacteralesOutcomesUrinary tract infectionKidney transplantationBackground 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 excludedWilley-BlackwellMedicinaMicrobiología2021info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/11441/137493https://doi.org/10.1111/tid.13520reponame:idUS. Depósito de Investigación de la Universidad de Sevillainstname:Universidad de Sevilla (US)InglésTransplant Infectious Disease, 23 (3), 1-16.http://doi.org/10.1111/tid.13520info:eu-repo/semantics/openAccessoai:idus.us.es:11441/1374932026-06-17T12:51:07Z
dc.title.none.fl_str_mv 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
title 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
spellingShingle 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
Pierrotti, L. C
Bloodstream infection
Carbapenem-sparing regimen
Extended-spectrum β-lactamase-producing Enterobacterales
Outcomes
Urinary tract infection
Kidney transplantation
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
dc.creator.none.fl_str_mv Pierrotti, L. C
Pérez-Nadales, E.
Fernández-Ruiz, M.
Gutiérrez Gutiérrez, Belén
Tan, B. H.
Carratalà, J.
Cordero Matia, María Elisa
Pascual Hernández, Álvaro
Rodríguez-Baño, Jesús
Aguado, J. M.
author Pierrotti, L. C
author_facet Pierrotti, L. C
Pérez-Nadales, E.
Fernández-Ruiz, M.
Gutiérrez Gutiérrez, Belén
Tan, B. H.
Carratalà, J.
Cordero Matia, María Elisa
Pascual Hernández, Álvaro
Rodríguez-Baño, Jesús
Aguado, J. M.
author_role author
author2 Pérez-Nadales, E.
Fernández-Ruiz, M.
Gutiérrez Gutiérrez, Belén
Tan, B. H.
Carratalà, J.
Cordero Matia, María Elisa
Pascual Hernández, Álvaro
Rodríguez-Baño, Jesús
Aguado, J. M.
author2_role author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Medicina
Microbiología
dc.subject.none.fl_str_mv Bloodstream infection
Carbapenem-sparing regimen
Extended-spectrum β-lactamase-producing Enterobacterales
Outcomes
Urinary tract infection
Kidney transplantation
topic Bloodstream infection
Carbapenem-sparing regimen
Extended-spectrum β-lactamase-producing Enterobacterales
Outcomes
Urinary tract infection
Kidney transplantation
description 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
publishDate 2021
dc.date.none.fl_str_mv 2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/11441/137493
https://doi.org/10.1111/tid.13520
url https://hdl.handle.net/11441/137493
https://doi.org/10.1111/tid.13520
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Transplant Infectious Disease, 23 (3), 1-16.
http://doi.org/10.1111/tid.13520
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv Willey-Blackwell
publisher.none.fl_str_mv Willey-Blackwell
dc.source.none.fl_str_mv reponame:idUS. Depósito de Investigación de la Universidad de Sevilla
instname:Universidad de Sevilla (US)
instname_str Universidad de Sevilla (US)
reponame_str idUS. Depósito de Investigación de la Universidad de Sevilla
collection idUS. Depósito de Investigación de la Universidad de Sevilla
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869417722134134784
score 15.300719

Similares en LA Referencia