Efficacy of ceftazidime-avibactam in solid organ transplant recipients with bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae.

Autor:	Pérez-Nadales E; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain. Electronic address: elena.pereznadales@imibic.org., Fernández-Ruiz M; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, '12 de Octubre' University Hospital, Instituto de Investigación Hospital '12 de Octubre' (imas12), Universidad Complutense, Madrid, Spain., Natera AM; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain., Gutiérrez-Gutiérrez B; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Department of Medicine and Microbiology, University of Seville, Institute of Biomedicine of Seville (University Hospital Virgen Macarena/CSIC/University of Seville), Seville, Spain., Mularoni A; Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy., Russelli G; Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy., Pierrotti LC; Department of Infectious Diseases, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., Pinheiro Freire M; Working Committee for Hospital Epidemiology and Infection Control, University of São Paulo School of Medicine Hospital das Clínicas, São Paulo, Brazil., Falcone M; Department of Clinical and Experimental Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy., Tiseo G; Department of Clinical and Experimental Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Italy., Tumbarello M; Dipartimento Biotecnologie Mediche, Università di Siena, Siena, Italy., Raffaelli F; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy., Abdala E; Faculdade de Medicina da Universidade de Sao Paulo, Instituto do Cancer do Estado de Sao Paulo, Brazil., Bodro M; Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain., Gervasi E; Infectious Diseases Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy., Fariñas MC; Department of Infectious Diseases, Marqués de Valdecilla University Hospital, University of Cantabria, Santander, Spain., Seminari EM; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Castón JJ; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Cordoba, Spain., Marín-Sanz JA; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain., Gálvez-Soto V; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain., Rana MM; Icahn School of Medicine at Mount Sinai, New York, New York, USA., Loeches B; Clinical Unit of Infectious Diseases, La Paz University Hospital, Madrid, Spain., Martín-Dávila P; Department of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain., Pascual Á; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Department of Medicine and Microbiology, University of Seville, Institute of Biomedicine of Seville (University Hospital Virgen Macarena/CSIC/University of Seville), Seville, Spain., Rodríguez-Baño J; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Clinical Unit of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, and Department of Medicine and Microbiology, University of Seville, Institute of Biomedicine of Seville (University Hospital Virgen Macarena/CSIC/University of Seville), Seville, Spain., Aguado JM; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Unit of Infectious Diseases, '12 de Octubre' University Hospital, Instituto de Investigación Hospital '12 de Octubre' (imas12), Universidad Complutense, Madrid, Spain., Martínez-Martínez L; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Department of Agricultural Chemistry, Soil Science and Microbiology, University of Cordoba, Cordoba, Spain; Clinical Unit of Microbiology, Reina Sofía University Hospital, Cordoba, Spain., Torre-Cisneros J; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spanish Network for Research in Infectious Diseases (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Reina Sofía University Hospital, Cordoba, Spain; Department of Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain; Clinical Unit of Infectious Diseases, Reina Sofía University Hospital, Cordoba, Spain.
Jazyk:	angličtina
Zdroj:	American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2023 Jul; Vol. 23 (7), pp. 1022-1034. Date of Electronic Publication: 2023 Apr 05.
DOI:	10.1016/j.ajt.2023.03.011
Abstrakt:	We aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902; Impact of Specific Antimicrobials and MIC Values on the Outcome of Bloodstream Infections Due to ESBL- or Carbapenemase-producing Enterobacterales in Solid Organ Transplantation: an Observational Multinational Study). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control, and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/149). Patients treated with CAZ-AVI had higher 14-day (80.7% vs 60.6%, P = .011) and 30-day (83.1% vs 60.6%, P = .004) clinical success and lower 30-day mortality (13.25% vs 27.3%, P = .053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.03-6.84; P = .044) and 30-day clinical success (aOR, 3.14; 95% CI, 1.17-8.40; P = .023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI. (Copyright © 2023 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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