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. 2021 Mar 7;10(1):50.
doi: 10.1186/s13756-021-00918-7.

Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018

Philipp Kohler #  1 , Aline Wolfensberger #  2 , Susanne Stampf  3 , Andreas Brönnimann  2 , Katia Boggian  4 , Christian van Delden  5 , Melody Favre  5 , Cédric Hirzel  6 , Nina Khanna  7 , Stefan P Kuster  2 , Oriol Manuel  8 , Dionysios Neofytos  5 , Silvio Ragozzino  7 , Peter W Schreiber  2 , Laura Walti  6 , Nicolas J Mueller  2 ; Swiss Transplant Cohort Study
Collaborators, Affiliations

Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018

Philipp Kohler et al. Antimicrob Resist Infect Control. .

Abstract

Background: The burden of antimicrobial resistance is high in solid organ transplant (SOT) recipients. Among Swiss SOT recipients, we assessed temporal trends of ESBL-producing Enterobacterales (ESBL-E), identified risk factors for ESBL-E, and assessed the impact of resistance on patient outcome.

Methods: Data from the Swiss Transplant Cohort Study (STCS), a nationwide prospective cohort of SOT-recipients, were analysed. Temporal trends were described for ESBL-detection among Escherichia coli and non-Escherichia coli. In a nested case-control study, cases with ESBL-E infection were 1:1 matched (by time since transplantation, organ transplant, pathogen) to controls infected with non-ESBL-E. Factors associated with resistance and with unfavourable 30-day outcome (death, infection relapse, graft loss) were assessed.

Results: From 2012 to 2018, we identified 1'212 infection episodes caused by Enterobacterales in 1'074 patients, thereof 11.4% (138/1'212) caused by ESBL-E. The proportion of ESBL-production among Escherichia coli remained stable over time (p = 0.93) but increased for non-E. coli (p = 0.02) Enterobacterales. In the case-control study (n = 102), antibiotic pre-treatment was independently associated with ESBL-production (aOR = 2.6, 95%-CI: 1.0-6.8, p = 0.046). Unfavourable outcome occurred in 24/51 (47%) cases and 9/51 (18%) controls (p = 0.003). Appropriate empiric antibiotic therapy was the only modifiable factor associated with unfavourable outcome.

Conclusions: In Swiss SOT-recipients, proportion of infections with ESBL-producing non-E. coli Enterobacterales increased in recent years. Antibiotic pre-treatment represents a risk factor for ESBL-E. Improving appropriateness of empiric antibiotic treatment might be an important measure to reduce unfavourable outcome, which was observed in almost half of SOT-recipients with ESBL-E infections.

Keywords: Enterobacterales; Extended-spectrum beta-lactamase; Renal transplant; Solid organ transplant; Switzerland.

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Conflict of interest statement

All authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Proportion of patients with ESBL-producing Escherichia coli (left) and non-E. coli (right) among all patients infected with the corresponding pathogen in the Swiss Transplant Cohort Study between 2012 and 2018
Fig. 2
Fig. 2
Histogram showing the time from transplant to onset of infection in days for 51 cases (above) and 51 controls (below)
See this image and copyright information in PMC

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