학술논문
Temporal trends, risk factors and outcomes of infections due to extended-spectrum [beta]-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018
Document Type
Clinical report
Author
Kohler, Philipp; Wolfensberger, Aline; Stampf, Susanne; Brönnimann, Andreas; Boggian, Katia; van Delden, Christian; Favre, Melody; Hirzel, Cédric; Khanna, Nina; Kuster, Stefan P.; Manuel, Oriol; Neofytos, Dionysios; Ragozzino, Silvio; Schreiber, Peter W.; Walti, Laura; Mueller, Nicolas J.; Amico, Patrizia; Axel, Andres; Aubert, John-David; Banz, Vanessa; Sonja, Beckmann; Beldi, Guido; Benden, Christian; Berger, Christoph; Binet, Isabelle; Bochud, Pierre-Yves; Branca, Sanda; Bucher, Heiner; Carrel, Thierry; Catana, Emmanuelle; Chalandon, Yves; de Geest, Sabina; de Rougemont, Olivier; Dickenmann, Michael; Dreifuss, Joëlle Lynn; Duchosal, Michel; Fehr, Thomas; Ferrari-Lacraz, Sylvie; Garzoni, Christian; Soccal, Paola Gasche; Gaudet, Christophe; Giostra, Emiliano; Golshayan, Déla; Hadaya, Karine; Halter, Jörg; Hauri, Dimitri; Heim, Dominik; Hess, Christoph; Hillinger, Sven; Hirsch, Hans; Hirt, Patricia; Hofbauer, Günther; Huynh-Do, Uyen; Immer, Franz; Koller, Michael; Laesser, Bettina; Lang, Brian; Lehmann, Roger; Leichtle, Alexander; Lovis, Christian; Manuel, Oriol; Marti, Hans-Peter; Martin, Pierre Yves; Martinelli, Michele; Mellac, Katell; Merçay, Aurélia; Mettler, Karin; Meylan, Pascal; Mueller, Nicolas; Müller, Antonia; Müller, Thomas; Müller-Arndt, Ulrike; Müllhaupt, Beat; Nägeli, Mirjam; Pascual, Manuel; Posfay-Barbe, Klara; Rick, Juliane; Rosselet, Anne; Rossi, Simona; Rothlin, Silvia; Ruschitzka, Frank; Schanz, Urs; Schaub, Stefan; Schnyder, Aurelia; Schuurmans, Macé; Simonetta, Federico; Staufer, Katharina; Stampf, Susanne; Steiger, Jürg; Stirniman, Guido; Toso, Christian; Van Delden, Christian; Venetz, Jean-Pierre; Villard, Jean; Wick, Madeleine; Wilhelm, Markus; Yerly, Patrick
Source
Antimicrobial Resistance and Infection Control. March 7, 2021, Vol. 10 Issue 1
Subject
Language
English
ISSN
2047-2994
Abstract
Background The burden of antimicrobial resistance is high in solid organ transplant (SOT) recipients. Among Swiss SOT recipients, we assessed temporal trends of ESBL-producing Enterobacterales (ESBL-E), identified risk factors for ESBL-E, and assessed the impact of resistance on patient outcome. Methods Data from the Swiss Transplant Cohort Study (STCS), a nationwide prospective cohort of SOT-recipients, were analysed. Temporal trends were described for ESBL-detection among Escherichia coli and non-Escherichia coli. In a nested case-control study, cases with ESBL-E infection were 1:1 matched (by time since transplantation, organ transplant, pathogen) to controls infected with non-ESBL-E. Factors associated with resistance and with unfavourable 30-day outcome (death, infection relapse, graft loss) were assessed. Results From 2012 to 2018, we identified 1'212 infection episodes caused by Enterobacterales in 1'074 patients, thereof 11.4% (138/1'212) caused by ESBL-E. The proportion of ESBL-production among Escherichia coli remained stable over time (p = 0.93) but increased for non-E. coli (p = 0.02) Enterobacterales. In the case-control study (n = 102), antibiotic pre-treatment was independently associated with ESBL-production (aOR = 2.6, 95%-CI: 1.0-6.8, p = 0.046). Unfavourable outcome occurred in 24/51 (47%) cases and 9/51 (18%) controls (p = 0.003). Appropriate empiric antibiotic therapy was the only modifiable factor associated with unfavourable outcome. Conclusions In Swiss SOT-recipients, proportion of infections with ESBL-producing non-E. coli Enterobacterales increased in recent years. Antibiotic pre-treatment represents a risk factor for ESBL-E. Improving appropriateness of empiric antibiotic treatment might be an important measure to reduce unfavourable outcome, which was observed in almost half of SOT-recipients with ESBL-E infections. Keywords: Solid organ transplant, Renal transplant, Extended-spectrum beta-lactamase, Enterobacterales, Switzerland
Author(s): Philipp Kohler[sup.1], Aline Wolfensberger[sup.2], Susanne Stampf[sup.3], Andreas Brönnimann[sup.2], Katia Boggian[sup.1], Christian van Delden[sup.4], Melody Favre[sup.4], Cédric Hirzel[sup.5], Nina Khanna[sup.6], Stefan P. Kuster[sup.2], Oriol Manuel[sup.7], Dionysios Neofytos[sup.4], Silvio Ragozzino[sup.6], Peter [...]
Author(s): Philipp Kohler[sup.1], Aline Wolfensberger[sup.2], Susanne Stampf[sup.3], Andreas Brönnimann[sup.2], Katia Boggian[sup.1], Christian van Delden[sup.4], Melody Favre[sup.4], Cédric Hirzel[sup.5], Nina Khanna[sup.6], Stefan P. Kuster[sup.2], Oriol Manuel[sup.7], Dionysios Neofytos[sup.4], Silvio Ragozzino[sup.6], Peter [...]