Infectious Diseases Division, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Madrid, Spain.
Transpl Infect Dis. 2021 Jun;23(3):e13520. doi: 10.1111/tid.13520. Epub 2021 Jan 4.
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.
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.
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.
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).
对于因尿路感染（UTI）继发产超广谱β-内酰胺酶肠杆菌科（ESBL-E）血流感染（BSI）的肾移植受者（KTR），与碳青霉烯类药物相比，含β-内酰胺/β-内酰胺酶抑制剂（BLBLI）的积极治疗是否同样有效，目前仍不清楚。
我们回顾性评估了 2014 年 1 月至 2016 年 10 月期间 30 个中心收治的 306 例 KTR。ESBL-E BSI 发病后第 7 天和第 30 天的治疗失败（无治愈或临床改善和/或任何原因导致的死亡）是主要和次要研究结局。
第 7 天和第 30 天治疗失败的患者分别占 8.2%（25/306）和 13.4%（41/306）。医院获得性 BSI（调整后的比值比[aOR]：4.10；95%置信区间[CI]：1.50-11.20）和 Pitt 评分（aOR：1.47；95% CI：1.21-1.77）与第 7 天的治疗失败独立相关。年龄调整后的 Charlson 指数（aOR：1.25；95% CI：1.05-1.48）、Pitt 评分（aOR：1.72；95% CI：1.35-2.17）和就诊时淋巴细胞计数≤500 个/μL（aOR：3.16；95% CI：1.42-7.06）预测第 30 天的治疗失败。碳青霉烯类单药治疗（68.6%，主要是美罗培南）是最常见的积极治疗方法，其次是 BLBLI 单药治疗（10.8%，主要是哌拉西林-他唑巴坦）。倾向评分（PS）调整模型显示，在最初 72 小时内，积极治疗选择（含碳青霉烯类药物与任何其他方案、BLBLI-与碳青霉烯类药物单药治疗）对任何研究结局均无显著影响。
我们的数据表明，对于因 UTI 继发 ESBL-E BSI 的 KTR 人群，BLBLI 为基础的积极治疗可能与含碳青霉烯类药物的方案同样有效。可能存在残留混杂因素和样本量不足（ClinicalTrials.gov 标识符：NCT02852902）。
