Outcome of Bacteremia Caused by Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae After Solid Organ Transplantation

Colonization with extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae in solid organ transplantation: A meta‐analysis and review

“…Moreover, infections in transplant patients pose several diagnostic and therapeutic challenges, and lack of prompt effective therapy leads to increased morbidity and mortality . Specifically, in a study of 997 transplant recipients, Aguiar et al . reported a 26% mortality and a 28% recurrence rate in patients with bloodstream infection caused by ESBL‐E.…”

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“…Extended-spectrum β-lactamase-positive Enterobacteriaceae are especially more common in nosocomial infections. They have also been identified as a major source of morbidity and mortality in solid-organ transplant recipients 20 because the management of infections caused by these agents is challenging as a result of a much higher likelihood of resistance to other antibiotics. 21,22 In our study, ESBL-positive Enterobacteriaceae were the causative organism is 56 infections, whereas ESBL-negative Enterobacteriaceae were the causative organism in 16 infections.…”

Antibiotic-Resistant Infections and Treatment Challenges in the Immunocompromised Host

“…8 With the exception of the studies from Al-Hasan and colleagues, 6 Azap and colleagues, 13 and Riera and colleagues, 9 the incidence of ESBL production in enteric pathogens was at least 40%. [6][7][8][9]11,12,14,21,23,25 Two other studies reported the proportion of enteric bacilli that were MDR (14.5% and 54.8%, respectively), but did not specify if these were ESBL producing or not. 26,28 One other study looked at the number of patients who were colonized with ESBL producing pathogens before liver transplantation.…”

“…Other studies with proportion of empiric antibiotics being appropriate included 21.6% in resistant Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species (ESKAPE pathogens) in the study by Bodro and colleagues, 7 38% in the study looking at incidence of ESBL-producing organisms in patients with Enterobacteriaceae bacteremia by Aguiar and colleagues, 12 and 42.3% in the study of MDR A baumannii infections by Kim and colleagues. 18 Interestingly, the study by Aguiar and colleagues 12 showed that use of appropriate empiric antibiotics was associated with increased mortality (6/10 [60%] of deaths vs 7/ 29 [24%] of survivors; P 5 .056) The authors concluded that this paradox was attributable to selection bias, because these patients typically were sicker with higher Charlson comorbidity index and Pitt bacteremia scores. Additionally, Kalil and colleagues 33 in their comparison of mortality owing to bacteremia in transplant versus nontransplant patients found that transplant patients are less likely to receive appropriate antibiotics (84% vs 98%).…”

“…Mortality was associated more commonly with increased severity of illness, whether it was by a specific system (Charlson comorbidity index, 12 Pitt bacteremia score, 12 SOFA score, 16 Acute Physiology And Chronic Health Evaluation [APACHE] II), 19 or by other objective data, for example, respiratory failure, 7 mechanical ventilation, 15,26 heart failure upon admission, 31 multiorgan system failure, 31 and septic shock. 10,26 One study looking at XDR A baumannii did assess type of therapy and mortality.…”