Treatment of carbapenemase-producing Enterobacterales bloodstream infections (CPE-BSI) in solid-organ transplant recipients (SOT) is challenging. The objective of this study was to develop a specific score to predict mortality in SOT recipients with CPE-BSI. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% CI 0.76-0.88) and classified patients into three strata: 0-7 (low mortality), 8-11 (high mortality) and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy versus combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted HR 2.82, 95% CI 1.13-7.06, P=0.03) and high (HR 9.93, 95% CI 2.08-47.40, P=0.004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
Predictors of mortality in solid-organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: the impact of cytomegalovirus disease and lymphopenia
Falcone, Marco;
2019-01-01
Abstract
Treatment of carbapenemase-producing Enterobacterales bloodstream infections (CPE-BSI) in solid-organ transplant recipients (SOT) is challenging. The objective of this study was to develop a specific score to predict mortality in SOT recipients with CPE-BSI. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% CI 0.76-0.88) and classified patients into three strata: 0-7 (low mortality), 8-11 (high mortality) and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy versus combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted HR 2.82, 95% CI 1.13-7.06, P=0.03) and high (HR 9.93, 95% CI 2.08-47.40, P=0.004) mortality risk strata. A score-based algorithm is provided for therapy guidance.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
