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http://hdl.handle.net/1843/55781| Tipo: | Artigo de Periódico |
| Título: | 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) |
| Autor(es): | Nicolas j Muller Oriol Manuel Hande Arslan Imran Hasanoglu Maria López Oliva Sheila Chiese Nicola Duccio Salerno Olivier Lortholary Mical Paul Anne Scemla Elisa Grazia Calvi Laurent Dewispelaere Paulo Henrique Orlandi Mourão Athina Pyrpasopoulou Iordanis Romiopoulos Elias Iosifidis Edson Abdala Marta Bodro Tania Mara Varejão Strabelli Noa Cohen'sinai María Carmen Fariñas Warren Lowman Marco Falcone Esra Kazak Mario Tumbarello Erika Lease Nina Nestorova Ligia C.pierrotti Francisco López'medrano Rafael San'juan Miguel Montejo Maristela p. Freire Elisa Cordero Miruna d. David Esperanza Merino Seema Mehta Steinke Paolo a. Grossi Ángela Cano Elena Pérez'nadales Elena m. Seminari Maricela Valerio Filiz Gunseren Meenakshi Rana Alessandra Mularoni Pilar Martín'dávila Christian Delden Melike Hamiyet Demirkaya Zeliha Koçak Tufan Belén Loeches Mario Fernández'ruiz Ranganathan n. Iyer Fabio Soldani Britt'marie Eriksson Benoît Pilmis Marco Rizzi Julien Coussement Wanessa Trindade Clemente Emmanuel Roilides Álvaro Pascual Luis Martínez'martínez Belén Gutiérrez'gutiérrez Jesús Rodríguez'baño Julian Torre'cisneros José María Aguado Terence yi Shern Kee Núria Sabé Mariana Camoez María a Domínguez Fidi Koppel Jaime Lora'tamayo Leyre Lopez'soria Ban Hock Tan Elias David'neto Flávio Jota de Paula e Flávia Rossi Jose Antonio Lepe Gabriel Bernal Blanco Cecilia Martín'gandul Noelia Balibrea Antonio Franco Robin Avery Darin Ostrander Daniela Dalla Gasperina Jordi Carratalà Cristina Rovelli Alejandra m Natera Manuel Recio'rufián Julia Guzmán'puche Cristina Leoni Patricia Muñoz Carlos Sánchez'carrillo Sara Lardo Deena Rose Altman Jesús Fortún Isabel Oriol Rosa Escudero Francesca Gioia |
| Resumo: | 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). |
| Assunto: | Sepse Transplante de rim Resultado de tratamento Infecções Urinárias |
| Idioma: | eng |
| País: | Brasil |
| Editor: | Universidade Federal de Minas Gerais |
| Sigla da Instituição: | UFMG |
| Departamento: | MED - DEPARTAMENTO DE PROPEDÊUTICA COMPLEMENTAR |
| Tipo de Acesso: | Acesso Restrito |
| Identificador DOI: | 10.1111/tid.13520 |
| URI: | http://hdl.handle.net/1843/55781 |
| Data do documento: | 2021 |
| metadata.dc.url.externa: | https://onlinelibrary.wiley.com/doi/10.1111/tid.13520 |
| metadata.dc.relation.ispartof: | Transplant Infectious Disease |
| Aparece nas coleções: | Artigo de Periódico |
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