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Abstract: Current guidelines recommend against systematic screening for or treating asymptomatic bacteriuria (AB) among kidney transplant (KT) recipients, although the evidence regarding episodes occurring early after transplantation or in the presence of anatomical abnormalities is inconclusive. Oral fosfomycin may constitute a good option for the treatment of posttransplant AB, particularly due to the emergence of multidrug-resistant (MDR) uropathogens. Available clinical evidence supporting its use in this specific setting, however, remains scarce. We performed a retrospective study in 14 Spanish institutions from January 2005 to December 2017. Overall, 137 episodes of AB diagnosed in 133 KT recipients treated with oral fosfomycin (calcium and trometamol salts) with a test-of-cure urine culture within the first 30 days were included. Median time from transplantation to diagnosis was 3.1 months (interquartile range [IQR], 1.1 to 10.5). Most episodes (96.4% [132/137]) were caused by Gram-negative bacteria (GNB), and 56.9% (78/137) were categorized as MDR (extended?spectrum ??lactamase?producing Enterobacterales [20.4%] and carbapenem?resistant GNB [2.9%]). Rate of microbiological failure at month 1 was 40.1% (95% confidence interval [CI], 31.9% to 48.9%) for the whole cohort and 42.3% (95% CI, 31.2% to 54.0%) for episodes due to MDR pathogens. Previous urinary tract infection (odds ratio [OR], 2.42; 95% CI, 1.11 to 5.29; P value = 0.027) and use of fosfomycin as salvage therapy (OR, 8.31; 95% CI, 1.67 to 41.35; P value = 0.010) were predictors of microbiological failure. No severe treatment-related adverse events were detected. Oral fosfomycin appears to be a suitable and safe alternative for the treatment (if indicated) of AB after KT, including those episodes due to MDR uropathogens.
Fuente: Antimicrob Agents Chemother, 2021, 65, e02267-20
Editorial: American Society for Microbiology
Fecha de publicación: 19/04/2021
Tipo de publicación: Artículo de Revista
DOI: doi.org/10.1128/AAC.02267-20
ISSN: 0066-4804,1098-6596,1070-6283
Url de la publicación: https://doi.org/10.1128/AAC.02267-20
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RUIZ RUIGÓMEZ, MARÍA
FERNÁNDEZ-RUIZ, MARIO
TIAGO SILVA, JOSÉ
VIDAL, ELISA
ORIGÜEN, JULIA
CALVO CANO, ANTONIA
LUNA HUERTA, ENRIQUE
MERINO, ESPERANZA
HERNÁNDEZ, DOMINGO
JIRONDA-GALLEGOS, CRISTINA
ESCUDERO SÁNCHEZ, ROSA
GIOIA, FRANCESCA
MORENO, ANTONIO
ROCA, CRISTINA
CORDERO, ELISA
JANERIO, DARÍO
CARLOS ARMIÑANZAS CASTILLO
MARIA DEL CARMEN FARIÑAS ALVAREZ
EMILIO RODRIGO CALABIA
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