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Title: | The role of therapy with aminoglycoside in the outcomes of kidney transplant recipients infected with polymyxin- and carbapenem-resistant Enterobacteriaceae |
Authors: | FREIRE, Maristela P.; GARCIA, Doroti de Oliveira; CURY, Ana Paula; FRANCISCO, Gabriela R.; SANTOS, Nathamy F. dos; SPADAO, Fernanda; BUENO, Maria Fernanda Campagnari; CAMARGO, Carlos Henrique; PAULA, Flavio J. de; ROSSI, Flavia; NAHAS, Willian C.; DAVID-NETO, Elias; PIERROTTI, Ligia C. |
Citation: | EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, v.38, n.4, p.755-765, 2019 |
Abstract: | Kidney transplant recipients are at risk for infections due to carbapenem-resistant Enterobacteriaceae (CRE). Polymyxin-resistant CRE (PR-CRE) infections are especially difficult to treat. The aim of this study was to characterize PR-CRE infections among kidney transplant recipients and identify risk factors for treatment failure. This retrospective cohort study involved all kidney transplant recipients with PR-CRE infection between 2013 and 2017 at our center. Minimal inhibitory concentrations for polymyxin B were determined by broth microdilution. Carbapenem-resistant genes (bla(KPC), bla(NDM), and bla(OXA-48)), aminoglycoside-resistance genes, and polymyxin-resistant gene mcr-1 were identified by polymerase chain reaction. All but one of the 47PR-CRE infections identified were due to Klebsiella pneumoniae. The most common type of infection (in 54.3%) was urinary tract infection (UTI). Monotherapy was used in 10 cases. Combined treatment regimens included double-carbapenem therapy in 19 cases, oral fosfomycin in 19, and amikacin in 13. Treatment failure occurred in 21 cases (45.7%). Clinical success was achieved 78.9% of patients who used aminoglycosides versus 37.0% of those who not used this drug (p=0.007). Multivariate analysis showed diabetes mellitus to be a risk factor for treatment failure; amikacin use and UTI were found to be protective. Nine strains were RmtB producers. Although aminoglycosides constitute an important therapeutic option for PR-CRE infection, the emergence of aminoglycoside resistance could have a major impact on the management of CRE infection. |
Appears in Collections: | Artigos e Materiais de Revistas Científicas - FM/MCG Artigos e Materiais de Revistas Científicas - HC/ICESP Artigos e Materiais de Revistas Científicas - HC/ICHC Artigos e Materiais de Revistas Científicas - LIM/03 Artigos e Materiais de Revistas Científicas - LIM/47 Artigos e Materiais de Revistas Científicas - LIM/55 Artigos e Materiais de Revistas Científicas - ODS/03 |
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