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. 2021 Jun;23(3):e13520.
doi: 10.1111/tid.13520. Epub 2021 Jan 4.

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)

Ligia C Pierrotti  1 , Elena Pérez-Nadales  2   3 , Mario Fernández-Ruiz  2   4 , Belén Gutiérrez-Gutiérrez  2   5 , Ban Hock Tan  6 , Jordi Carratalà  2   7 , Isabel Oriol  2   7 , Mical Paul  8 , Noa Cohen-Sinai  9 , Francisco López-Medrano  2   4 , Rafael San-Juan  2   4 , Miguel Montejo  10 , Maristela P Freire  11 , Elisa Cordero  2   12 , Miruna D David  13 , Esperanza Merino  14 , Seema Mehta Steinke  15 , Paolo A Grossi  16 , Ángela Cano  2   5 , Elena M Seminari  17 , Maricela Valerio  18 , Filiz Gunseren  19 , Meenakshi Rana  20 , Alessandra Mularoni  21 , Pilar Martín-Dávila  2   22 , Christian van Delden  23 , Melike Hamiyet Demirkaya  24 , Zeliha Koçak Tufan  25 , Belén Loeches  26 , Ranganathan N Iyer  27 , Fabio Soldani  28 , Britt-Marie Eriksson  29 , Benoît Pilmis  30 , Marco Rizzi  31 , Julien Coussement  32 , Wanessa T Clemente  33 , Emmanuel Roilides  34 , Álvaro Pascual  2   5 , Luis Martínez-Martínez  2   35 , Jesús Rodríguez-Baño  2   5 , Julian Torre-Cisneros  2   36 , José María Aguado  2   4 ; Investigators from the REIPI/INCREMENT-SOT Group
Collaborators, Affiliations
Free article

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)

Ligia C Pierrotti et al. Transpl Infect Dis. 2021 Jun.
Free article

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).

Keywords: bloodstream infection; carbapenem-sparing regimen; extended-spectrum β-lactamase-producing Enterobacterales; kidney transplantation; outcomes; urinary tract infection.

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References

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