The role of therapy with aminoglycoside in the outcomes of kidney transplant recipients infected with polymyxin- and carbapenem-resistant Enterobacteriaceae

Autor: Flávio Jota de Paula, Fernanda Spadão, Maria Fernanda Campagnari Bueno, Carlos Henrique Camargo, Gabriela Rodrigues Francisco, Flavia Rossi, Willian Nahas, Nathamy F Dos Santos, Doroti de Oliveira Garcia, Maristela Pinheiro Freire, Ana Paula Cury, Lígia Camera Pierrotti, Elias David-Neto
Rok vydání: 2019
Předmět:
Adult
Male
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
Klebsiella pneumoniae
030106 microbiology
Microbial Sensitivity Tests
Carbapenem-resistant enterobacteriaceae
Fosfomycin
03 medical and health sciences
0302 clinical medicine
Medical microbiology
Enterobacteriaceae
Risk Factors
Drug Resistance
Multiple
Bacterial
Internal medicine
Escherichia coli
medicine
Humans
Polymyxins
Treatment Failure
030212 general & internal medicine
Risk factor
Amikacin
Aged
Retrospective Studies
biology
business.industry
Enterobacteriaceae Infections
Retrospective cohort study
General Medicine
Middle Aged
biology.organism_classification
Kidney Transplantation
Transplant Recipients
Anti-Bacterial Agents
Aminoglycosides
Carbapenem-Resistant Enterobacteriaceae
Treatment Outcome
Infectious Diseases
Drug Therapy
Combination
Female
business
Polymyxin B
medicine.drug
Zdroj: European Journal of Clinical Microbiology & Infectious Diseases. 38:755-765
ISSN: 1435-4373
0934-9723
DOI: 10.1007/s10096-019-03468-4
Popis: Kidney transplant recipients are at risk for infections due to carbapenem-resistant Enterobacteriaceae (CRE). Polymyxin-resistant CRE (PR-CRE) infections are especially difficult to treat. The aim of this study was to characterize PR-CRE infections among kidney transplant recipients and identify risk factors for treatment failure. This retrospective cohort study involved all kidney transplant recipients with PR-CRE infection between 2013 and 2017 at our center. Minimal inhibitory concentrations for polymyxin B were determined by broth microdilution. Carbapenem-resistant genes (blaKPC, blaNDM, and blaOXA-48), aminoglycoside-resistance genes, and polymyxin-resistant gene mcr-1 were identified by polymerase chain reaction. All but one of the 47PR-CRE infections identified were due to Klebsiella pneumoniae. The most common type of infection (in 54.3%) was urinary tract infection (UTI). Monotherapy was used in 10 cases. Combined treatment regimens included double-carbapenem therapy in 19 cases, oral fosfomycin in 19, and amikacin in 13. Treatment failure occurred in 21 cases (45.7%). Clinical success was achieved 78.9% of patients who used aminoglycosides versus 37.0% of those who not used this drug (p = 0.007). Multivariate analysis showed diabetes mellitus to be a risk factor for treatment failure; amikacin use and UTI were found to be protective. Nine strains were RmtB producers. Although aminoglycosides constitute an important therapeutic option for PR-CRE infection, the emergence of aminoglycoside resistance could have a major impact on the management of CRE infection.
Databáze: OpenAIRE
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