Article
Extended-spectrum beta-lactamase-producing and carbapenem-resistant enterobacterales bloodstream infection after solid organ transplantation: recent trends in epidemiology and therapeutic approaches
Author/s | Pérez-Nadales, Elena
Fernández-Ruiz, Mario Gutiérrez-Gutiérrez, Belén Pascual, Álvaro Rodríguez-Baño, Jesús Torre-Cisneros, Julian |
Department | Universidad de Sevilla. Departamento de Sevilla |
Publication Date | 2022 |
Deposit Date | 2024-02-26 |
Published in |
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Abstract | Background: Infections caused by multidrug-resistant gram-negative bacilli (MDR
GNB), in particular extended-spectrum β-lactamase-producing (ESBL-E) and
carbapenem-resistant Enterobacterales (CRE), pose a major threat ... Background: Infections caused by multidrug-resistant gram-negative bacilli (MDR GNB), in particular extended-spectrum β-lactamase-producing (ESBL-E) and carbapenem-resistant Enterobacterales (CRE), pose a major threat in solid organ transplantation (SOT). Outcome prediction and therapy are challenging due to the scarcity of randomized clinical trials (RCTs) or well-designed observational studies focused on this population. Methods: Narrative review with a focus on the contributions provided by the ongoing multinational INCREMENT-SOT consortium (ClinicalTrials identifier NCT02852902) in the fields of epidemiology and clinical management. Results: The Spanish Society of Transplantation (SET), the Group for Study of Infection in Transplantation of the Spanish Society of Infectious Diseases and Clinical Microbi- ology (GESITRA-SEIMC), and the Spanish Network for Research in Infectious Diseases (REIPI) recently published their recommendations for the management of MDR GNB infections in SOT recipients. We revisit the SET/GESITRA-SEIMC/REIPI document tak- ing into consideration new evidence that emerged on the molecular epidemiology, prognostic stratification, and treatment of post-transplant ESBL-E and CRE infections. Results derived from the INCREMENT-SOT consortium may support the therapeu- tic approach to post-transplant bloodstream infection (BSI). The initiatives devoted to sparing the use of carbapenems in low-risk ESBL-E BSI or to repurposing existing non-β-lactam antibiotics for CRE in both non-transplant and transplant patients are reviewed, as well as the eventual positioning in the specific SOT setting of recently approved antibiotics. Conclusion: Due to the clinical complexity and relative rarity of ESBL-E and CRE infec- tions in SOT recipients, multinational cooperative efforts such as the INCREMENT- SOT Project should be encouraged. In addition, RCTs focused on post-transplant serious infection remain urgently needed. |
Citation | Pérez-Nadales, E., Fernández-Ruiz, M., Gutiérrez-Gutiérrez, B., Pascual, Á., Rodríguez-Baño, J. y Torre-Cisneros, J. (2022). Extended-spectrum beta-lactamase-producing and carbapenem-resistant enterobacterales bloodstream infection after solid organ transplantation: recent trends in epidemiology and therapeutic approaches. transplant infectious disease, 4 (2), e 138881. https://doi.org/10.1111/tid.13881. |