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Abstract: We aimed to compare the efficacy of ceftazidime-avibactam (CAZ-AVI) versus the best available therapy (BAT) in solid organ transplant (SOT) recipients with bloodstream infection caused by carbapenemase-producing Klebsiella pneumoniae (CPKP-BSI). A retrospective (2016-2021) observational cohort study was performed in 14 INCREMENT-SOT centers (ClinicalTrials.gov identifier: NCT02852902; Impact of Specific Antimicrobials and MIC Values on the Outcome of Bloodstream Infections Due to ESBL- or Carbapenemase-producing Enterobacterales in Solid Organ Transplantation: an Observational Multinational Study). Outcomes were 14-day and 30-day clinical success (complete resolution of attributable manifestations, adequate source control, and negative follow-up blood cultures) and 30-day all-cause mortality. Multivariable logistic and Cox regression analyses adjusted for the propensity score to receive CAZ-AVI were constructed. Among 210 SOT recipients with CPKP-BSI, 149 received active primary therapy with CAZ-AVI (66/149) or BAT (83/149). Patients treated with CAZ-AVI had higher 14-day (80.7% vs 60.6%, P = .011) and 30-day (83.1% vs 60.6%, P = .004) clinical success and lower 30-day mortality (13.25% vs 27.3%, P = .053) than those receiving BAT. In the adjusted analysis, CAZ-AVI increased the probability of 14-day (adjusted odds ratio [aOR], 2.65; 95% confidence interval [CI], 1.03-6.84; P = .044) and 30-day clinical success (aOR, 3.14; 95% CI, 1.17-8.40; P = .023). In contrast, CAZ-AVI therapy was not independently associated with 30-day mortality. In the CAZ-AVI group, combination therapy was not associated with better outcomes. In conclusion, CAZ-AVI may be considered a first-line treatment in SOT recipients with CPKP-BSI
Fuente: American journal of transplantation, 2023, 23(7), 1022-1034
Publisher: Wiley Periodicals Inc.
Year of publication: 2023
No. of pages: 13
Publication type: Article
DOI: 10.1016/j.ajt.2023.03.011
ISSN: 1600-6135,1600-6143
Spanish project: RD16/0016/0008
Publication Url: https://doi.org/10.1016/j.ajt.2023.03.011
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PÉREZ-NADALES, ELENA
FERNÁNDEZ-RUIZ, MARIO
NATERA, ALEJANDRA M.
GUTIÉRREZ-GUTIÉRREZ, BELÉN
MULARONI, ALESSANDRA
RUSSELLI, GIOVANNA
CAMERA PIERROTTI, LIGIA
PINHEIRO FREIRE, MARISTELA
FALCONE, MARCO
RISEO, GIUSY
TUMBARELLO, MARIO
RAFFAELLI, FRANCESCA
ABDALA, EDSON
BODRO, MARTA
GERVASI, ELENA
MARIA DEL CARMEN FARIÑAS ALVAREZ
SEMINARI, ELENA M.
CASTÓN, JUAN JOSÉ
MARÍN-SANZ, JUAN ANTONIO
GÁLVEZ-SOTO, VÍCTOR
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