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

Overview

Journal Antimicrob Resist Infect Control

Publisher Biomed Central

Specialty Infectious Diseases

Date 2021 Mar 8

PMID 33678189

Citations 6

Authors

Philipp Kohler

Aline Wolfensberger

Susanne Stampf

Andreas Bronnimann

Katia Boggian

Christian Van Delden

Melody Favre

Cedric Hirzel

Nina Khanna

Stefan P Kuster

Oriol Manuel

Dionysios Neofytos

Silvio Ragozzino

Peter W Schreiber

Laura Walti

Nicolas J Mueller

Affiliations

Soon will be listed here.

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.

Citing Articles

Timeline and Incidence of Infectious Complications in Older Transplant Recipients During the First Year Post-Transplantation.

Ayaz C, Ceylan S, Yilmaz V, Adanir H, Turhan O Pathogens. 2025; 13(12.

PMID: 39770321 PMC: 11728761. DOI: 10.3390/pathogens13121061.

Burden and Management of Multi-Drug Resistant Organism Infections in Solid Organ Transplant Recipients Across the World: A Narrative Review.

Freire M, Pouch S, Manesh A, Giannella M Transpl Int. 2024; 37:12469.

PMID: 38952482 PMC: 11215024. DOI: 10.3389/ti.2024.12469.

Frequency and impact on renal transplant outcomes of urinary tract infections due to extended-spectrum beta-lactamase-producing and .

Brune J, Dickenmann M, Sidler D, Walti L, Golshayan D, Manuel O Front Med (Lausanne). 2024; 11:1329778.

PMID: 38426162 PMC: 10902035. DOI: 10.3389/fmed.2024.1329778.

Gram-negative bacteremia in solid organ transplant recipients: Clinical characteristics and outcomes as compared to immunocompetent non-transplant recipients.

Eichenberger E, Troy J, Ruffin F, Dagher M, Thaden J, Ford M Transpl Infect Dis. 2022; 24(6):e13969.

PMID: 36411527 PMC: 9780155. DOI: 10.1111/tid.13969.

Antimicrobial stewardship programs in solid-organ transplant recipients in Switzerland.

Bielicki J, Manuel O Transpl Infect Dis. 2022; 24(5):e13902.

PMID: 36254517 PMC: 9788035. DOI: 10.1111/tid.13902.

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