Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia.
antibiotic drug resistance
clinical research/practice
infection and infectious agents - bacterial
infectious disease
organ transplantation in general
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
31 12 2019
31 12 2019
Historique:
received:
27
06
2019
revised:
30
11
2019
accepted:
22
12
2019
pubmed:
1
1
2020
medline:
1
1
2020
entrez:
1
1
2020
Statut:
aheadofprint
Résumé
Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. 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% confidence interval [CI] 0.76-0.88) and classified patients into 3 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 vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.
Identifiants
pubmed: 31891235
doi: 10.1111/ajt.15769
pii: S1600-6135(22)22362-4
doi:
Banques de données
ClinicalTrials.gov
['NCT02852902']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : ESCMID Study Group for Infections in Compromised Hosts (ESGICH)
Organisme : Sociedad Andaluza de Trasplante de Órgano Sólido (SATOT)
Organisme : Plan Nacional de I+D+i 2013-2016
Organisme : Instituto de Salud Carlos III
Organisme : Subdirección General de Redes y Centros de Investigación Cooperativa
Organisme : Innovación y Universidades
Organisme : Spanish Network for Research in Infectious Diseases
ID : RD16/0016/0008
Organisme : Spanish Network for Research in Infectious Diseases
ID : RD16/0016/0001
Organisme : Spanish Network for Research in Infectious Diseases
ID : RD16/0016/0002
Organisme : Spanish Network for Research in Infectious Diseases
ID : RD16/0016/00010
Investigateurs
A T Wan Song
(AT)
W Andraus
(W)
L A Carneiro D'Albuquerque
(LA)
E David-Neto
(E)
F Jota de Paula
(F)
F Rossi
(F)
D Ostrander
(D)
R Avery
(R)
M Rizzi
(M)
A R Losito
(AR)
F Raffaelli
(F)
P Del Giacomo
(P)
G Tiseo
(G)
J Lora-Tamayo
(J)
R San-Juan
(R)
I Gracia-Ahufinger
(I)
J Castón
(J)
Y A Ruiz
(YA)
D R Altman
(DR)
S V Campos
(SV)
N Bar-Sinai
(N)
F Koppel
(F)
F Arnaiz de Las Revillas Almajano
(F)
C González Rico
(C)
M Fernández Martínez
(M)
P H O Mourão
(PHO)
F A Neves
(FA)
J Ferreira
(J)
A Pyrpasopoulou
(A)
E Iosifidis
(E)
I Romiopoulos
(I)
M V Minero
(MV)
C Sánchez-Carrillo
(C)
S Lardo
(S)
J Coussement
(J)
M Dodémont
(M)
K Jiayun
(K)
P Martín-Dávila
(P)
J Fortún
(J)
M Almela
(M)
A Moreno
(A)
L Linares
(L)
D D Gasperina
(DD)
M L Balsamo
(ML)
C Rovelli
(C)
E Concia
(E)
S Chiesi
(S)
D N Salerno
(DN)
D Ogunc
(D)
B Pilmis
(B)
E M Seminari
(EM)
J Carratalá
(J)
A Domínguez
(A)
E Cordero
(E)
J A Lepe
(JA)
M Montejo
(M)
E Merino de Lucas
(E)
B M Eriksson
(BM)
C van Delden
(C)
O Manuel
(O)
H Arslan
(H)
Z Koçak Tufan
(Z)
E Kazak
(E)
M David
(M)
E Lease
(E)
N Nestorova
(N)
G Cornaglia
(G)
M Akova
(M)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.
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