Belén Gutiérrez-Gutiérrez1, Elena Salamanca1, Marina de Cueto1, Po-Ren Hsueh2, Pierluigi Viale3, José Ramón Paño-Pardo4, Mario Venditti5, Mario Tumbarello6, George Daikos7, Vicente Pintado8, Yohei Doi9, Felipe Francisco Tuon10, Ilias Karaiskos11, Isabel Machuca12, Mitchell J Schwaber13, Özlem Kurt Azap14, Maria Souli15, Emmanuel Roilides16, Spyros Pournaras17, Murat Akova18, Federico Pérez19, Joaquín Bermejo20, Antonio Oliver21, Manel Almela22, Warren Lowman23, Benito Almirante24, Robert A Bonomo25, Yehuda Carmeli26, David L Paterson27, Alvaro Pascual28, Jesús Rodríguez-Baño29. 1. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain. 2. National Taiwan University Hospital, Taipei, Taiwan. 3. Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy. 4. Hospital Universitario La Paz-IDIPAZ, Madrid, Spain; Hospital Clínico Universitario "Lozano Blesa"-IIS Aragón, Zaragoza, Spain. 5. Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy. 6. Catholic University of the Sacred Heart, Rome, Italy. 7. National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece. 8. Hospital Ramón y Cajal, Madrid, Spain. 9. University of Pittsburgh, Pittsburgh, PA. 10. Hospital da Universidade Federal do Parana, Curitiba, Brazil. 11. Hygeia General Hospital, Athens, Greece. 12. Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain. 13. Tel Aviv Sourasky Medical Center, Tel Aviv, Israel. 14. Baskent University Faculty of Medicine, Ankara, Turkey. 15. University General Hospital Attikon, Chaidiri, Greece. 16. Hippokration Hospital, Thessaloniki, Greece. 17. Medical School, University of Thessaly, Larissa, Greece. 18. Hacettepe University School of Medicine, Ankara, Turkey. 19. Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH. 20. Hospital Español, Rosario, Argentina. 21. Hospital Universitario Son Espases, Palma de Mallorca, Spain. 22. Hospital Clinic, Barcelona, Spain. 23. Wits Donald Gordon Medical Centre, Johannesburg, South Africa. 24. Hospital Vall d'Hebrón, Barcelona, Spain. 25. Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH. 26. Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel. 27. University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia. 28. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain; Departamento de Microbiología, Universidad de Sevilla, Seville, Spain. 29. Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain. Electronic address: jesusrb@us.es.
Abstract
OBJECTIVE: To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). PATIENTS AND METHODS: A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. RESULTS: The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. CONCLUSION: A validated score predictive of early mortality in patients with BSIs due to CPE was developed. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01 764490.
OBJECTIVE: To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). PATIENTS AND METHODS: A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. RESULTS: The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. CONCLUSION: A validated score predictive of early mortality in patients with BSIs due to CPE was developed. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01 764490.
Authors: Zaira Raquel Palacios-Baena; Belén Gutiérrez-Gutiérrez; Marina De Cueto; Pierluigi Viale; Mario Venditti; Alicia Hernández-Torres; Antonio Oliver; Luis Martínez-Martínez; Esther Calbo; Vicente Pintado; Oriol Gasch; Benito Almirante; José Antonio Lepe; Johann Pitout; Murat Akova; Carmen Peña-Miralles; Mitchell J Schwaber; Mario Tumbarello; Evelina Tacconelli; Julia Origüen; Nuria Prim; German Bou; Helen Giamarellou; Joaquín Bermejo; Axel Hamprecht; Federico Pérez; Manuel Almela; Warren Lowman; Po-Ren Hsueh; Carolina Navarro-San Francisco; Julián Torre-Cisneros; Yehuda Carmeli; Robert A Bonomo; David L Paterson; Álvaro Pascual; Jesús Rodríguez-Baño Journal: J Antimicrob Chemother Date: 2017-03-01 Impact factor: 5.790
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Authors: Heather Henderson; Courtney L Luterbach; Eric Cober; Sandra S Richter; Robert A Salata; Robert C Kalayjian; Richard R Watkins; Yohei Doi; Keith S Kaye; Scott Evans; Vance G Fowler; Robert A Bonomo; Anthony Harris; Sonia Napravnik; David Van Duin Journal: Clin Infect Dis Date: 2020-04-15 Impact factor: 9.079
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