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Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018

Philipp Kohler, Aline Wolfensberger, Susanne Stampf, Andreas Brönnimann, Katia Boggian, Christian Van Delden, Melody Favre, Cédric Hirzel, Nina Khanna, Stefan P Kuster, Oriol Manuel, Dionysios Neofytos, Silvio Ragozzino, Peter W Schreiber, Laura Walti, Nicolas J Mueller & Swiss Transplant Cohort Study

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.
   
citation Kohler P, Wolfensberger A, Stampf S, Brönnimann A, Boggian K, van Delden C, Favre M, Hirzel C, Khanna N, Kuster S P, Manuel O, Neofytos D, Ragozzino S, Schreiber P W, Walti L, Mueller N J, Swiss Transplant Cohort Study . Temporal trends, risk factors and outcomes of infections due to extended-spectrum β-lactamase producing Enterobacterales in Swiss solid organ transplant recipients between 2012 and 2018. Antimicrob Resist Infect Control 2021; 10:50.
   
type journal paper/review (English)
date of publishing 07-03-2021
journal title Antimicrob Resist Infect Control (10/1)
ISSN electronic 2047-2994
pages 50
PubMed 33678189
DOI 10.1186/s13756-021-00918-7