| Title: |
Targeted peri-operative prophylaxis in patients colonized with Carbapenem Resistant Enterobacterales undergoing Liver Transplantation: a multinational cohort study |
| Authors: |
Rinaldi, Matteo; Miani, Beatrice; Gibertoni, Dino; Di Chiara, Michela; Lopes, Carolina Andrade; Cona, Andrea; Mularoni, Alessandra; De Rosa, Francesco Giuseppe; Franceschini, Erica; Ghidoni, Elena; Ferrarese, Alberto; Burra, Patrizia; Halpern, Màrcia; Camargo, Luis Fernando Aranha; Bandera, Alessandra; Valerio, Maricela; Merli, Marco; Ramos-Martinez, Antonio; Vena, Antonio; Girao, Evelyne Santana; Yahav, Dafna; Peghin, Maddalena; Grossi, Paolo; de Abreu Guimarães, Luiz Felipe; Viale, Pierluigi; Freire, Maristela; Giannella, Maddalena; Simone, Francesca; Caroccia, Natascia; Giovagnorio, Federico; Siniscalchi, Antonio; Laici, Cristiana; Ambretti, Simone; Mirabella, Stefano; Romagnoli, Renato; Corcione, Silvia; Lauritano, Carola; Alagna, Laura; Rivolta, Chiara; Muscatello, Antonio; Mangioni, Davide; Gori, Andrea; Antonelli, Barbara; Dondossola, Daniele; Rossi, Giorgio; Invernizzi, Federica; D'Amico, Federico; Puoti, Massimo; Battistella, Sara; Cillo, Umberto |
| Source: |
Clinical Infectious Diseases ; ISSN 1058-4838 1537-6591 |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2026 |
| Description: |
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. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/cid/ciag185 |
| DOI: |
10.1093/cid/ciag185/67503336/ciag185.pdf |
| Availability: |
https://doi.org/10.1093/cid/ciag185; https://academic.oup.com/cid/advance-article-pdf/doi/10.1093/cid/ciag185/67503336/ciag185.pdf |
| Rights: |
https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Accession Number: |
edsbas.CDA33F8F |
| Database: |
BASE |