Efficacy of β-lactam/β-lactamase inhibitors to treat extended-spectrum beta-lactamase-producing Enterobacterales bacteremia secondary to urinary tract infection in kidney transplant recipients (INCREMENT-SOT Project)

REIPI/INCREMENT-SOT Group.[Background] 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.[Methods] 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.[Results] 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.[Conclusions] 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).This work was supported by: (1) Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [RD16/0016/0001, RD16/0016/0002, REIPI RD16/0016/0008; RD16/0016/00010], co-financed by European Development Regional Fund “A way to achieve Europe”, Operative Program Intelligent Growth 2014-2020; (2) European Society of Clinical Microbiology and Infectious diseases Study Group for Infections in Compromised Hosts (ESGICH, grant to J.M.A.); (3) Sociedad Andaluza de Trasplante de Órgano Sólido (SATOT, grant to L.M.M.); (4) Research project PI16/01631 integrated into the Plan Estatal de I+D+I 2013-2016 and co-financed by the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación and the Fondo Europeo de Desarrollo Regional (FEDER); (5) M.F.R. holds a research contract “Miguel Servet” (CP 18/00073) from ISCIII, Ministerio de Ciencia, Innovación y Universidades. The work was also supported by the following European Society of Clinical Microbiology and Infectious diseases (ESCMID) study groups: Infections in Compromised Hosts (ESGICH), Bloodstream Infections and Sepsis (ESGBIS) and Antimicrobial Resistance Surveillance (ESGARS).Peer reviewe

Study of causative agent & their susceptibility pattern in sepsis in young infants below 3 months of age

Introduction: Pathogens causing blood stream infections and their antibiotic susceptibility patterns constantly change over time & it is essential to monitor the epidemiology of infections to design appropriate antibiotic policy. Methodology: Blood culture reports of Children below 3 months of age admitted to our hospital over a period of 4 years were analysed to find the causative agents of sepsis & their antibiotic susceptibilities. All data were collected in validated preformatted proforma sheet & analysed using appropriate statistical methods. Results: Among 1401 blood cultures, culture positive growth was observed in 226 cases (16.1 %). In our study, Klebsiella pneumoniae was the commonest isolated in 23.4 % of blood cultures. Acinetobacter baumanii was the next commonest organism isolated in 13.7 % followed by MRSA growth in 11.9 %, MSSA in 4.8 %, E.coli in 8.8 %, Enterococcus faecalis in 7.5 %, B.cepacia in 6.6 %, P. aeruginosa in 5.3% & Enterobacter in 4.4 % of blood cultures. About 49% of K. pneumoniae were susceptible to Carbapenam & 60% of E.coli were susceptible to Amikacin & Tobramycin. All Enterobacter were sensitive to Imipenam, Meropenam, Ertapenam & Amikacin & 77% of A.baumanii were sensitive to Carbapenam. Yeasts were isolated in 8.4 %, the commonest being Candida tropicalis. Conclusion: It is essential to closely monitor the bacterial flora and their antibiotic sensitivity pattern to evolve rational antibiotic policy which is suitable for each unit. Guidelines on the reduction of emergence of drug resistance must be provided and instituted within the units