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Perioperative prophylaxis with ertapenem reduced infections caused by extended-spectrum betalactamase-producting Enterobacteriaceae after kidney transplantation.
Sanclemente, Gemma; Bodro, Marta; Cervera, Carlos; Linares, Laura; Cofán, Frederic; Marco, Francesc; Bosch, Jordi; Oppenheimer, Federico; Dieckmann, Fritz; Moreno, Asunción.
Affiliation
  • Sanclemente G; Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
  • Bodro M; Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain. mbodro@clinic.ub.es.
  • Cervera C; Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
  • Linares L; Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
  • Cofán F; Kidney Transplant Unit, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
  • Marco F; Department of Microbiology, Centre Diagnòstic Biomèdic (CDB), Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
  • Bosch J; Department of Microbiology, Centre Diagnòstic Biomèdic (CDB), Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
  • Oppenheimer F; Kidney Transplant Unit, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
  • Dieckmann F; Kidney Transplant Unit, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
  • Moreno A; Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
BMC Nephrol ; 20(1): 274, 2019 07 22.
Article in En | MEDLINE | ID: mdl-31331289
BACKGOUND: In recent years we have witnessed an increase in infections due to multidrug-resistant organisms in kidney transplant recipients (KTR). In our setting, we have observed a dramatic increase in infections caused by extended-spectrum betalactamase-producing (ESBL) Enterobacteriaceae in KTR. In 2014 we changed surgical prophylaxis from Cefazolin 2 g to Ertapenem 1 g. METHODS: We compared bacterial infections and their resistance phenotype during the first post-transplant month with an historical cohort collected during 2013 that had received Cefazolin. RESULTS: During the study period 110 patients received prophylaxis with Cefazolin and 113 with Ertapenem. In the Ertapenem cohort we observed a non-statistically significant decrease in the percentage of early bacterial infection from 57 to 47%, with urine being the most frequent source in both. The frequency of infections caused by Enterobacteriaceae spp. decreased from 64% in the Cefazolin cohort to 36% in the Ertapenem cohort (p = 0.005). In addition, percentage of ESBL-producing strains decreased from 21 to 8% of all Enterobacteriaceae isolated (p = 0.015). After adjusted in multivariate Cox regression analysis, male sex (HR 0.16, 95%CI: 0.03-0.75), cefazolin prophylaxis (HR 4.7, 95% CI: 1.1-22.6) and acute rejection (HR 14.5, 95% CI: 1.3-162) were associated to ESBL- producing Enterobacteriaceae infection. CONCLUSIONS: Perioperative antimicrobial prophylaxis with a single dose of Ertapenem in kidney transplant recipients reduced the incidence of early infections due to ESBL-producing Enterobacteriaceae without increasing the incidence of other multidrug-resistant microorganisms or C. difficile.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Postoperative Complications / Cefazolin / Antibiotic Prophylaxis / Enterobacteriaceae Infections / Ertapenem / Anti-Bacterial Agents Type of study: Observational_studies / Risk_factors_studies Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: BMC Nephrol Journal subject: NEFROLOGIA Year: 2019 Type: Article Affiliation country: Spain

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Postoperative Complications / Cefazolin / Antibiotic Prophylaxis / Enterobacteriaceae Infections / Ertapenem / Anti-Bacterial Agents Type of study: Observational_studies / Risk_factors_studies Limits: Adult / Aged / Female / Humans / Male / Middle aged Language: En Journal: BMC Nephrol Journal subject: NEFROLOGIA Year: 2019 Type: Article Affiliation country: Spain