title: Outcome of bacteremia caused by extended-spectrum β-lactamase-producing Enterobacteriaceae after solid organ transplantation.
abstract: BACKGROUND
  Although infection with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) has been recognized as an important cause of morbidity after solid organ transplantation, there are limited data on the outcome of this complication among transplant recipients. The objective of this study was to describe the outcome and factors associated with mortality among recipients of abdominal solid organ transplants with bloodstream infection caused by ESBL-E.
  
  
  METHODS
  This study was a retrospective analysis of a case series of patients who had bacteremia caused by ESBL-E after undergoing renal or liver transplantation between January 2000 and September 2008 at a university-affiliated hospital in Rio de Janeiro, Brazil. The primary end point of the study was death within 30 days of the diagnosis of bacteremia.
  
  
  RESULTS
  During the study period, 997 subjects underwent kidney (759 patients) or liver (238 patients) transplantation. Fifty-four episodes of bacteremia caused by ESBL-E were diagnosed in 39 patients (4%). Mortality after the first episode of ESBL-E bacteremia was 26% (10 deaths). In multiple logistic regression analysis, the Pitt bacteremia score (P = .005) and being on mechanical ventilation at the time of infection diagnosis (P = .02) were the only variables associated with mortality. Thirteen episodes of recurrent bacteremia occurred in 8 (28%) of the 29 patients who survived the first episode. Two (25%) of these 8 patients died during the course of a recurrent episode.
  
  
  CONCLUSIONS
  Bacteremia caused by ESBL-E was associated with high mortality and high risk of recurrence. Factors associated with clinical severity at the time of infection diagnosis were the main predictors of mortality.
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: E B
authors.initials: EB
authors.lastname: Aguiar
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: L C
authors.initials: LC
authors.lastname: Maciel
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: M
authors.initials: M
authors.lastname: Halpern
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: A S
authors.initials: AS
authors.lastname: de Lemos
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: A L P
authors.initials: AL
authors.lastname: Ferreira
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: S T
authors.initials: ST
authors.lastname: Basto
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: R T
authors.initials: RT
authors.lastname: Gonçalves
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: E F
authors.initials: EF
authors.lastname: de Gouvêa
authors.affiliation: Infectious Disease Clinic, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. Electronic address: santorolopes@hucff.ufrj.br.
authors.forename: G
authors.initials: G
authors.lastname: Santoro-Lopes
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D015415:Biomarkers / Q000378:metabolism; D003131:Combined Modality Therapy; D004755:Enterobacteriaceae / Q000378:metabolism; D004756:Enterobacteriaceae Infections / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016377:Organ Transplantation; D011183:Postoperative Complications / Q000401:mortality* / Q000628:therapy; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D015415:Biomarkers; D001618:beta-Lactamases