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

Article Article scientifique Article 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 eng 2021-03-07 2021-03-07 author Kohler Philipp 0000-0003-0427-8934 author Wolfensberger Aline author Stampf Susanne author Brönnimann Andreas author Boggian Katia author Van Delden Christian 24088 author Favre Melody 729904 author Hirzel Cédric author Khanna Nina author Kuster Stefan P author Manuel Oriol author Neofytos Dionysios 911674 author Ragozzino Silvio 0000-0002-8100-2096 author Schreiber Peter W author Walti Laura author Mueller Nicolas J collaborator Chalandon Yves 0000-0001-9341-8104 644957 collaborator Gasche-Soccal Paola Marina Alessandra 33623 collaborator Gaudet-Blavignac Christophe 0000-0001-6527-5898 645533 collaborator Lovis Christian 0000-0002-2681-8076 29016 collaborator Martin Pierre-Yves 65591 collaborator Posfay Barbe Klara 39230 collaborator Simonetta Federico 936876 collaborator Toso Christian 0000-0003-1652-4522 92271 collaborator Villard Jean 29595 Swiss Transplant Cohort Study 50 10.1186/s13756-021-00918-7 33678189 2047-2994 PMC7938519 https://aricjournal.biomedcentral.com/articles/10.1186/s13756-021-00918-7 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. Enterobacterales Extended-spectrum beta-lactamase Renal transplant Solid organ transplant Switzerland Dewey 616 Swiss National Science Foundation Antibiotic resistant gram-negative pathogens in Switzerland: Epidemiology in nursing homes and detection of patient clusters across different institutions and clinical settings 179919 CH Careers 56 Département de médecine 221 false 1216 Leucémie et transplantation allogénique de cellules souches hématopoïétiques 982 235 Perception du Quorum et gènes de virulence 301 298 Transplantation immunologie et osteoimmunologie 561 515 Recherche en infectiologie pédiatrique et en pédiatrie générale 853 562 Transplantation et hépatologie 905 344 Interfaces Homme-machine en milieu clinique 610 952 Groupe Gasche-Soccal Paola 958 Antimicrobial resistance and infection control 10 1 0df93287-8268-456e-9756-c41214348bd9 Article (Published version) Public Article-scientifique-from-europePmc.pdf 1286283 application/pdf CC BY-4.0 openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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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	Antimicrobial resistance and infection control	2021	388	160
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