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The role of therapy with aminoglycoside in the outcomes of kidney transplant recipients infected with polymyxin- and carbapenem-resistant Enterobacteriaceae

  • Maristela P. FreireEmail author
  • Doroti de Oliveira Garcia
  • Ana Paula Cury
  • Gabriela R. Francisco
  • Nathamy F. dos Santos
  • Fernanda Spadão
  • Maria Fernanda Campagnari Bueno
  • Carlos Henrique Camargo
  • Flavio J. de Paula
  • Flavia Rossi
  • Willian C. Nahas
  • Elias David-Neto
  • Ligia C. Pierrotti
Original Article

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 (blaKPC, blaNDM, and blaOXA-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.

Keywords

Polymyxin resistance Kidney transplant Fosfomycin Double carbapenem Mortality Treatment 

Notes

Compliance with ethical standards

The study was approved by our Institutional Review Board and due to its retrospective study design, patient informed consent was waived.

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Maristela P. Freire
    • 1
    Email author
  • Doroti de Oliveira Garcia
    • 2
  • Ana Paula Cury
    • 3
  • Gabriela R. Francisco
    • 2
  • Nathamy F. dos Santos
    • 2
  • Fernanda Spadão
    • 1
  • Maria Fernanda Campagnari Bueno
    • 2
  • Carlos Henrique Camargo
    • 2
  • Flavio J. de Paula
    • 4
  • Flavia Rossi
    • 3
  • Willian C. Nahas
    • 4
  • Elias David-Neto
    • 4
  • Ligia C. Pierrotti
    • 5
  1. 1.Working Committee for Hospital Epidemiology and Infection ControlUniversity of São Paulo School of Medicine Hospital das ClínicasSão PauloBrazil
  2. 2.Bacteriology CenterAdolfo Lutz InstituteSão PauloBrazil
  3. 3.Microbiology Section, Central LaboratoryUniversity of São Paulo School of Medicine Hospital das ClínicasSão PauloBrazil
  4. 4.Renal Transplantation Unit, Department of UrologyUniversity of São Paulo School of Medicine Hospital das ClínicasSão PauloBrazil
  5. 5.Department of Infectious DiseasesUniversity of São Paulo School of Medicine Hospital das ClínicasSão PauloBrazil

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