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Published on: May 7, 2015
Targeted peri-operative prophylaxis in patients colonized with Carbapenem Resistant Enterobacterales undergoing Liver
Matteo Rinaldi1,2, Beatrice Miani1, Dino Gibertoni3
1Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.
Background:
Targeted perioperative prophylaxis (T-PAP) has been proposed to mitigate the impact of Carbapenem-Resistant Enterobacterales (CRE) infections in patients colonized with CRE who are undergoing liver transplantation (LT). This study aims to investigate the impact of T-PAP versus standard perioperative prophylaxis (S-PAP) in preventing CRE infections.
Methods:
Observational, multinational cohort study of adults with CRE colonization at LT. The endpoints were CRE infection within 15 and 30 days after LT. Exposure was T-PAP defined as the use of agents with in vitro activity against the colonizing strain. T-PAP was differentiated into T-PAP with old drugs (T-PAPold) and T-PAP with novel drugs (T-PAPnew) according to the regimens used. T-PAPnew included patients exposed to new betalactam/betalactamse inhibitors (BL/BLIs) or cefiderocol. Treatment-effect models with augmented inverse probability weighting were employed to assess the average treatment effect (ATE) of T-PAPold and T-PAPnew versus S-PAP on CRE infection.
Results:
A total of 408 CRE pre-transplant carriers were included. T-PAPold was administered to 112 patients (27.5%), and T-PAPnew was administered to 28 patients (6.9%). Post-transplant CRE infection at 15 and 30 days occurred in 87 (21.4%) and 106 (26.0%) patients, respectively. The ATE of T-PAPnew at 15 and 30 days post-transplant was -0.146 (p=0.002) and -0.056 (p=0.320), respectively. The ATE of TPAPold at 15 and 30 days post-transplant was 0.003 (p=0.941) and -0.005 (p=0.897) respectively.
Conclusions:
The protective effect of T-PAPnew in preventing CRE infections is significant within the first 15 days, but its effectiveness decreases within the first month.
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