Risk Factors for Extended-Spectrum β-lactamase–Producing Enterobacterales Bloodstream Infection Among Solid-Organ Transplant Recipients.
| Autor: | Anesi, Judith A, Lautenbach, Ebbing, Tamma, Pranita D, Thom, Kerri A, Blumberg, Emily A, Alby, Kevin, Bilker, Warren B, Werzen, Alissa, Tolomeo, Pam, Omorogbe, Jacqueline, Pineles, Lisa, Han, Jennifer H |
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RESEARCH
CONFIDENCE intervals ADRENOCORTICAL hormones MULTIVARIATE analysis ENTEROBACTERIACEAE diseases MEDICAL cooperation CASE-control method IMMUNOSUPPRESSION RISK assessment CEPHALOSPORINS BETA lactamases DESCRIPTIVE statistics LOGISTIC regression analysis ODDS ratio TRANSPLANTATION of organs tissues etc. TRIMETHOPRIM DISEASE risk factors |
| Zdroj: | Clinical Infectious Diseases; 3/15/2021, Vol. 72 Issue 6, p953-960, 8p |
| Abstrakt: | Background Approximately 40% of all Enterobacterales (EB) bloodstream infections (BSIs) among solid organ transplant recipients (SOTRs) are due to extended-spectrum β-lactamase (ESBL)–producing organisms, but risk factors for such infections remain ill defined in this population. We sought to determine the risk factors for ESBL-EB BSIs among SOTRs. Methods A multicenter case-control study was performed. All SOTRs with an EB BSI at the Hospital of the University of Pennsylvania and University of Maryland Medical Center between 1 January 2007 and 30 June 2018 and at The Johns Hopkins Hospital between 1 January 2005 and 31 December 2015 were included. Cases were those with an ESBL-EB BSI. Controls were those with a non–ESBL-EB BSI. Multivariable logistic regression was performed to determine risk factors for ESBL-EB BSI. Results There were 988 episodes of EB BSI, of which 395 (40%) were due to an ESBL-EB. On multivariable analysis, the independent risk factors for ESBL-EB BSI included: ESBL-EB on prior culture (aOR, 12.75; 95% CI, 3.23–50.33; P < .001), a corticosteroid-containing immunosuppression regimen (aOR 1.30; 95% CI 1.03–1.65; P = .030), acute rejection treated with corticosteroids (aOR 1.18; 95% CI 1.16–1.19; P < .001), and exposure to third-generation cephalosporins (aOR 1.95; 95% CI 1.48–2.57; P < .001), echinocandins (aOR 1.61; 95% CI 1.08–2.40; P = .020), and trimethoprim-sulfamethoxazole (aOR 1.35; 95% CI 1.10–1.64; P = .003). Conclusions We identified several novel risk factors that are uniquely important to the SOTR population, including exposure to trimethoprim-sulfamethoxazole and corticosteroid-containing immunosuppressive regimens. Further studies exploring these associations and testing interventions aimed at these modifiable risk factors among SOTRs are needed. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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