Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients
Por:
Gutierrez-Gutierrez, B, Perez-Nadales, E, Perez-Galera, S, Fernandez-Ruiz, M, Carratala, J, Oriol, I, Cordero, E, Lepe, J, Tan, B, Corbella, L, Paul, M, Natera, A, David, M, Montejo, M, Iyer, R, Pierrotti, L, Merino, E, Steinke, S, Rana, M, 003-003, Mularoni, A, van Delden, C, Grossi, P, Seminari, E, Gunseren, F, Lease, E, Roilides, E, Fortun, J, Arslan, H, Coussement, J, Tufan, Z, Pilmis, B, Rizzi, M, Loeches, B, Eriksson, B, Abdala, E, Soldani, F, Lowman, W, Clemente, W, Bodro, M, Farinas, M, Kazak, E, Martinez-Martinez, L, Aguado, J, Torre-Cisneros, J, Pascual, A, Rodriguez-Bano, J and Investigators REIPI ESGICH ESGBIS
Publicada:
1 oct 2021
Ahead of Print:
9 ago 2021
Resumen:
There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment 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 meropenem 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 meropenem) 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.
Filiaciones:
Gutierrez-Gutierrez, B:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Seville, Virgen Macarena Univ Hosp, Inst Biomed Seville, Clin Unit Infect Dis & Microbiol, Seville, Spain
Perez-Nadales, E:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Cordoba, Spain
Perez-Galera, S:
Virgen Macarena Univ Hosp, Clin Unit Internal Med, Seville, Spain
Fernandez-Ruiz, M:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Complutense, Inst Invest Sanitaria Hosp 12 Octubre Imas12, Unit Infect Dis, 12 Octubre Univ Hosp, Madrid, Spain
Carratala, J:
Univ Barcelona, Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Dept Infect Dis, Barcelona, Spain
Oriol, I:
Univ Barcelona, Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Dept Infect Dis, Barcelona, Spain
Cordero, E:
Virgen del Rocio Univ Hosp, Clin Unit Infect Dis Microbiol & Prevent Med, Seville, Spain
Lepe, J:
Virgen del Rocio Univ Hosp, Clin Unit Infect Dis Microbiol & Prevent Med, Seville, Spain
Tan, B:
Singapore Gen Hosp, Dept Infect Dis, Singapore, Singapore
Corbella, L:
Univ Complutense, Inst Invest Sanitaria Hosp 12 Octubre Imas12, Unit Infect Dis, 12 Octubre Univ Hosp, Madrid, Spain
Paul, M:
Rambam Hlth Care Campus, Infect Dis Inst, Haifa, Israel
Natera, A:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Cordoba, Spain
David, M:
Univ Hosp Birmingham NHS Fdn Trust, Birmingham, W Midlands, England
Montejo, M:
Cruces Univ Hosp, Infect Dis Unit, Bilbao, Spain
Iyer, R:
Global Hosp, Clin Microbiol Identificat & Infect Control, Hyderabad, India
Pierrotti, L:
Univ Sao Paulo, Hosp Clin, Infect Dis Div, Med Sch, Sao Paulo, Brazil
:
Gen Univ Hosp Alicante, Unit Infect Dis, ISABIAL, Alicante, Spain
Steinke, S:
Johns Hopkins Univ, Sch Med, Baltimore, MD USA
Rana, M:
Icahn Sch Med Mt Sinai, New York, NY 10029 USA
003-003:
Univ Complutense Madrid, Serv Microbiol Clin & Enfermedades Infecciosas, Hosp Gen Univ Gregorio Maranon,CIBER Enfermedades, Inst Invest Sanitaria Gregorio Maranon,Fac Med, Madrid, Spain
Mularoni, A:
IRCCS ISMETT, Palermo, Italy
van Delden, C:
Univ Hosp Geneva, Unit Transplant Infect Dis, Geneva, Switzerland
Swiss Transplant Cohort Study STCS, Geneva, Switzerland
Grossi, P:
Univ Insubria, Varese Natl Ctr Transplantat, Dept Med & Surg, Infect Dis Sect, Rome, Italy
Seminari, E:
Fdn IRCCS Policlin San Matteo Pavia, Div Infect Dis, Pavia, Italy
Gunseren, F:
Akdeniz Univ, Dept Infect Dis & Clin Microbiol, Fac Med, Antalya, Turkey
Lease, E:
Univ Washington, Div Pulm Crit Care & Sleep Med, Seattle, WA 98195 USA
Roilides, E:
Aristotle Univ Thessaloniki, Sch Hlth Sci, Hippokrat Gen Hosp, Fac Med,Infect Dis Unit, Thessaloniki, Greece
Aristotle Univ Thessaloniki, Sch Hlth Sci, Hippokrat Gen Hosp, Fac Med,Dept Pediat 3, Thessaloniki, Greece
Fortun, J:
Ramon y Cajal Univ Hosp, Madrid, Spain
Arslan, H:
Bakent Univ, Sch Med, Ankara, Turkey
Coussement, J:
Univ Libre Bruxelles, Div Infect Dis, CUB Hop Erasme, Brussels, Belgium
Tufan, Z:
Ankara Yildirim Beyazit Univ, Infect Dis & Clin Microbiol Dept, Med Sch, Ankara, Turkey
Pilmis, B:
Paris Descartes Univ, Necker Enfants Malad Univ Hosp, AP HP,Inst Imagine, Dept Infect Dis & Trop Med,Ctr Infectiol Necker P, Paris, France
Rizzi, M:
ASST Papa Giovanni XXIII, Infect Dis Unit, Bergamo, Italy
Loeches, B:
Hosp La Paz, Infect Dis Unit, Madrid, Spain
Eriksson, B:
Uppsala Univ, Dept Med Sci, Sect Infect Dis, Uppsala, Sweden
Abdala, E:
Univ Sao Paulo, Fac Med, Sao Paulo, Brazil
Soldani, F:
Azienda Osped Univ Integrata Verona, Dept Med, Infect Dis Unit, Verona, Italy
Lowman, W:
Univ Witwatersrand, Fac Hlth Sci, Wits Donald Gordon Med Ctr, Pathcare Vermaak, Johannesburg, South Africa
Clemente, W:
Univ Fed Minas Gerais HC UFMG, Hosp Clin, Fac Med, Inst Alfa Gastroenterol,Grp Transplante Figado, Belo Horizonte, MG, Brazil
Bodro, M:
Univ Barcelona, Hosp Clin IDIBAPS, Infect Dis Dept, Barcelona, Spain
Farinas, M:
Univ Cantabria, Hosp Univ Marques de Valdecilla, Infect Dis Unit, Santander, Spain
Kazak, E:
Uludag Univ, Bursa, Turkey
Martinez-Martinez, L:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Dept Microbiol,Clin Unit Microbiol, Cordoba, Spain
Aguado, J:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Complutense, Inst Invest Sanitaria Hosp 12 Octubre Imas12, Unit Infect Dis, 12 Octubre Univ Hosp, Madrid, Spain
Torre-Cisneros, J:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Clin Unit Infect Dis, Cordoba, Spain
Pascual, A:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Seville, Virgen Macarena Univ Hosp, Inst Biomed Seville, Clin Unit Infect Dis & Microbiol, Seville, Spain
Rodriguez-Bano, J:
Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Seville, Virgen Macarena Univ Hosp, Inst Biomed Seville, Clin Unit Infect Dis & Microbiol, Seville, Spain
Green Published
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