A propensity score and door-based analysis Ertapenem for treatment of non-severe bacteremic urinary-tract infections due to esbl-producing in kidney transplant recipients
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Universidade Federal de Minas Gerais
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Artigo de periódico
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Resumo
There are scarce data on the efficacy of ertapenem in the treatment of bac teremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales(ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treat ment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT,NCT02852902). The association between targeted therapy with ertapenem versus merope nem and clinical cure at day 14 (the principal outcome) was studied by logistic regression.Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with merope nem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome.In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages
Abstract
Assunto
Ertapenem, Infecções Urinárias, Unidades de Terapia Intensiva, Sepse, Transplante de Rim
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Ertapenem, Extended-spectrum-b-lactamase-producing Enterobacterales, ESBL-E, Urinary tract infection, UT, Bloodstream infection, BSI, Kidney transplantation
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https://journals.asm.org/doi/10.1128/AAC.01102-21?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed