Risk Factors for Extended-Spectrum ß-lactamase-Producing Enterobacterales Bloodstream Infection Among Solid-Organ Transplant Recipients.
Clin Infect Dis
; 72(6): 953-960, 2021 03 15.
Article
em En
| MEDLINE
| ID: mdl-32149327
ABSTRACT
BACKGROUND:
Approximately 40% of all Enterobacterales (EB) bloodstream infections (BSIs) among solid organ transplant recipients (SOTRs) are due to extended-spectrum ß-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; Pâ <â .001), a corticosteroid-containing immunosuppression regimen (aOR 1.30; 95% CI 1.03-1.65; Pâ =â .030), acute rejection treated with corticosteroids (aOR 1.18; 95% CI 1.16-1.19; Pâ <â .001), and exposure to third-generation cephalosporins (aOR 1.95; 95% CI 1.48-2.57; Pâ <â .001), echinocandins (aOR 1.61; 95% CI 1.08-2.40; Pâ =â .020), and trimethoprim-sulfamethoxazole (aOR 1.35; 95% CI 1.10-1.64; Pâ =â .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.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Bacteriemia
/
Sepse
/
Infecções por Enterobacteriaceae
Tipo de estudo:
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Humans
Idioma:
En
Ano de publicação:
2021
Tipo de documento:
Article