Risk Factors for Extended-Spectrum β-lactamase–Producing Enterobacterales Bloodstream Infection Among Solid-Organ Transplant Recipients

Abstract

Background Approximately 40% of all Enterobacterales (EB) bloodstream infections (BSIs) among solid organ transplant recipients (SOTRs) are due to extended-spectrum β-lactamase (ESBL)–producing organisms, but risk factors for such infections remain ill defined in this population. We sought to determine the risk factors for ESBL-EB BSIs among SOTRs. Methods A multicenter case-control study was performed. All SOTRs with an EB BSI at the Hospital of the University of Pennsylvania and University of Maryland Medical Center between 1 January 2007 and 30 June 2018 and at The Johns Hopkins Hospital between 1 January 2005 and 31 December 2015 were included. Cases were those with an ESBL-EB BSI. Controls were those with a non–ESBL-EB BSI. Multivariable logistic regression was performed to determine risk factors for ESBL-EB BSI. Results There were 988 episodes of EB BSI, of which 395 (40%) were due to an ESBL-EB. On multivariable analysis, the independent risk factors for ESBL-EB BSI included: ESBL-EB on prior culture (aOR, 12.75; 95% CI, 3.23–50.33; P < .001), a corticosteroid-containing immunosuppression regimen (aOR 1.30; 95% CI 1.03–1.65; P = .030), acute rejection treated with corticosteroids (aOR 1.18; 95% CI 1.16–1.19; P < .001), and exposure to third-generation cephalosporins (aOR 1.95; 95% CI 1.48–2.57; P < .001), echinocandins (aOR 1.61; 95% CI 1.08–2.40; P = .020), and trimethoprim-sulfamethoxazole (aOR 1.35; 95% CI 1.10–1.64; P = .003). Conclusions We identified several novel risk factors that are uniquely important to the SOTR population, including exposure to trimethoprim-sulfamethoxazole and corticosteroid-containing immunosuppressive regimens. Further studies exploring these associations and testing interventions aimed at these modifiable risk factors among SOTRs are needed.

Perioperative anidulafungin combined with triazole prophylaxis for the prevention of early invasive candidiasis in lung transplant recipients

“…4,24 In multivariable analysis, when modeled with LAS, dehiscence, and donor fungal colonization, protocolized anidulafungin use did not show a significant association with reduced IFI incidence. Whereas a recent multicenter study of 897 solid organ transplant recipients, including 65 LTRs, reported potential risk of Enterobacterales and extended-spectrum β-lactamase producing Enterobacterales infection with echinocandin exposure, 25 our findings suggest that echinocandin use was not associated with increased incidence of overall bacterial or Enterobacterales infections. consistent with prior studies showing the highest risk for Candida infections among LTRs in the first postoperative month.…”

Klebsiella pneumoniae pneumonia in patients with rheumatic autoimmune diseases: clinical characteristics, antimicrobial resistance and factors associated with extended-spectrum β-lactamase production

“…Instead, dose of corticosteroid therapy was an independent risk factor for ESBL-positive Kp pneumonia. It has been reported that corticosteroid use is correlated with ESBL production in nosocomial infections and bloodstream infections by several studies [24][25][26]. In this pneumonia cohort, the majority of the patients were receiving corticosteroids, and those administered with higher doses were more likely to be infected with ESBL-positive K. pneumoniae, which may be explained by hyperglycemia and impaired cellular immunity associated with corticosteroid use [27,28].…”

Klebsiella pneumoniae pneumonia in patients with rheumatic autoimmune diseases: clinical characteristics, antimicrobial resistance and factors associated with extended-spectrum β-lactamase production

“…Instead, dose of corticosteroid therapy was an independent risk factor for ESBL-positive Kp pneumonia. It has been reported that corticosteroid use is correlated with ESBL production in nosocomial infections and bloodstream infections by several studies [ 25 – 27 ]. In this pneumonia cohort, the majority of the patients were receiving corticosteroids, and those administered with higher doses were more likely to be infected with ESBL-positive K. pneumoniae , which may be explained by hyperglycemia and impaired cellular immunity associated with corticosteroid use [ 28 , 29 ].…”