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
Gutiérrez-Gutiérrez, Belén Pérez-Nadales, Elena Pérez-Galera, Salvador Fernández-Ruiz, Mario Carratalà, Jordi Oriol, Isabel Cordero, Elisa Lepe, José Antonio Tan, Ban Hock Corbella, Laura
Gutiérrez-Gutiérrez, Belén
Pérez-Nadales, Elena
Pérez-Galera, Salvador
Fernández-Ruiz, Mario
Carratalà, Jordi
Oriol, Isabel
Cordero, Elisa
Lepe, José Antonio
Tan, Ban Hock
Corbella, Laura
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Affiliation
Spanish Network for Research in Infectious Diseases; University of Seville; Virgen Macarena University Hospital; University of Cordoba; Reina Sofia University Hospital; "12 de Octubre" University Hospital; Universidad Complutense; Bellvitge University Hospital; University of Barcelona; Virgen del Rocío University Hospital; Singapore General Hospital; Rambam Health Care Campus; University Hospitals Birmingham NHS Foundation Trust; Cruces University Hospital; Global Hospitals, Hyderabad; University of São Paulo Medical School; General University Hospital of Alicante; Johns Hopkins University; Icahn School of Medicine at Mount Sinai; Hospital General Universitario Gregorio Marañón; Universidad Complutense de Madrid; IRCCS ISMETT; University Hospitals of Geneva; Swiss Transplant Cohort Study; University of Insubria; National Center for Transplantation, Rome; Fondazione IRCCS Policlinico San Matteo Pavia; Akdeniz University Faculty of Medicine; University of Washington; Aristotle University School of Health Sciences; Hippokration General Hospital; Ramón y Cajal University Hospital; Bakent University School of Medicine; CUB-Hôpital Erasme; Université Libre de Bruxelles; Medical School of Ankara Yildirim Beyazit University; Paris Descartes University; Assitance Publique des Hopitaux de Paris; ASST Papa Giovanni XXIII; Hospital La Paz; Uppsala University; Azienda Ospedaliera Universitaria Integrata di Verona; University of the Witwatersrand; Universidad de Federal Minas Gerais; Hospital Universitario Marqués de Valdecilla; University of Cantabria; Uludag University
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Publication date
2021-08-09
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Abstract
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.
Citation
Gutiérrez-Gutiérrez B, Pérez-Nadales E, Pérez-Galera S, Fernández-Ruiz M, Carratalà J, Oriol I, Cordero E, Lepe JA, Tan BH, Corbella L, Paul M, Natera AM, David MD, Montejo M, Iyer RN, Pierrotti LC, Merino E, Steinke SM, Rana MM, Muñoz P, Mularoni A, van Delden C, Grossi PA, Seminari EM, Gunseren F, Lease ED, Roilides E, Fortún J, Arslan H, Coussement J, Tufan ZK, Pilmis B, Rizzi M, Loeches B, Eriksson BM, Abdala E, Soldani F, Lowman W, Clemente WT, Bodro M, Fariñas MC, Kazak E, Martínez-Martínez L, Aguado JM, Torre-Cisneros J, Pascual Á, Rodríguez-Baño J; Investigators from the REIPI/ESGICH/ESGBIS/INCREMENT-SOT Group. 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. Antimicrob Agents Chemother. 2021 Oct 18;65(11):e0110221. doi: 10.1128/AAC.01102-21. Epub 2021 Aug 9.
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Article