Propensity score and desirability of outcome ranking analysis of ertapenem for treatment of nonsevere bacteremic urinary tract infections due to extended-spectrum-beta-lactamase-producing enterobacterales in kidney transplant recipients
Gutiérrez-Gutiérrez, Belén Pérez-Nadales, Elena Pérez-Galera, Salvador Fernández-Ruiz, Mario Carratalà, Jordi Oriol, Isabel Cordero, Elisa Lepe, José Antonio Tan, Ban Hock Corbella, Laura
Gutiérrez-Gutiérrez, Belén
Pérez-Nadales, Elena
Pérez-Galera, Salvador
Fernández-Ruiz, Mario
Carratalà, Jordi
Oriol, Isabel
Cordero, Elisa
Lepe, José Antonio
Tan, Ban Hock
Corbella, Laura
Abstract
There are scarce data on the efficacy of ertapenem in the treatment of bacteremia due to extended-spectrum-beta-lactamase (ESBL)-producing Enterobacterales (ESBL-E) in kidney transplant (KT) recipients. We evaluated the association between treatment with ertapenem or meropenem and clinical cure in KT recipients with nonsevere bacteremic urinary tract infections (B-UTI) caused by ESBL-E. We performed a registered, retrospective, international (29 centers in 14 countries) cohort study (INCREMENT-SOT, NCT02852902). The association between targeted therapy with ertapenem versus meropenem and clinical cure at day 14 (the principal outcome) was studied by logistic regression. Propensity score matching and desirability of outcome ranking (DOOR) analyses were also performed. A total of 201 patients were included; only 1 patient (treated with meropenem) in the cohort died. Clinical cure at day 14 was reached in 45/100 (45%) and 51/101 (50.5%) of patients treated with ertapenem and meropenem, respectively (adjusted OR 1.29; 95% CI 0.51 to 3.22; P = 0.76); the propensity score-matched cohort included 55 pairs (adjusted OR for clinical cure at day 14, 1.18; 95% CI 0.43 to 3.29; P = 0.74). In this cohort, the proportion of cases treated with ertapenem with better DOOR than with meropenem was 49.7% (95% CI, 40.4 to 59.1%) when hospital stay was considered. It ranged from 59 to 67% in different scenarios of a modified (weights-based) DOOR sensitivity analysis when potential ecological advantage or cost was considered in addition to outcome. In conclusion, targeted therapy with ertapenem appears as effective as meropenem to treat nonsevere B-UTI due to ESBL-E in KT recipients and may have some advantages.
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Date
2021-08-09
Type
Article
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Citation
Gutiérrez-Gutiérrez B, Pérez-Nadales E, Pérez-Galera S, Fernández-Ruiz M, Carratalà J, Oriol I, Cordero E, Lepe JA, Tan BH, Corbella L, Paul M, Natera AM, David MD, Montejo M, Iyer RN, Pierrotti LC, Merino E, Steinke SM, Rana MM, Muñoz P, Mularoni A, van Delden C, Grossi PA, Seminari EM, Gunseren F, Lease ED, Roilides E, Fortún J, Arslan H, Coussement J, Tufan ZK, Pilmis B, Rizzi M, Loeches B, Eriksson BM, Abdala E, Soldani F, Lowman W, Clemente WT, Bodro M, Fariñas MC, Kazak E, Martínez-Martínez L, Aguado JM, Torre-Cisneros J, Pascual Á, Rodríguez-Baño J; Investigators from the REIPI/ESGICH/ESGBIS/INCREMENT-SOT Group. Propensity Score and Desirability of Outcome Ranking Analysis of Ertapenem for Treatment of Nonsevere Bacteremic Urinary Tract Infections Due to Extended-Spectrum-Beta-Lactamase-Producing Enterobacterales in Kidney Transplant Recipients. Antimicrob Agents Chemother. 2021 Oct 18;65(11):e0110221. doi: 10.1128/AAC.01102-21. Epub 2021 Aug 9.
Journal / Source Title
Antimicrobial Agents and Chemotherapy
DOI
10.1128/AAC.01102-21
PMID
34370578
Publisher
American Society for Microbiology
Publisher’s URL
https://journals.asm.org/journal/aac