A predictive model of mortality in patients with bloodstream infections due to carbapenemase-producing enterobacteriaceae

Gutierrez-Gutierrez, Belen, Salamanca, Elena, de Cueto, Marina, Hsueh, Po-Ren, Viale, Pierluigi, Ramon Pano-Pardo, Jose, Venditti, Mario, Tumbarello, Mario, Daikos, George, Pintado, Vicente, Doi, Yohei, Francisco Tuon, Felipe, Karaiskos, Ilias, Machuca, Isabel, Schwaber, Mitchell J., Azap, Ozlem Kurt, Souli, Maria, Roilides, Emmanuel, Pournaras, Spyros, Akova, Murat, Perez, Federico, Bermejo, Joaquin, Oliver, Antonio, Almela, Manel, Lowman, Warren, Almirante, Benito, Bonomo, Robert A., Carmeli, Yehuda, Paterson, David L., Pascual, Alvaro and Rodriguez-Bano, Jesus (2016) A predictive model of mortality in patients with bloodstream infections due to carbapenemase-producing enterobacteriaceae. Mayo Clinic Proceedings, 91 10: 1362-1371. doi:10.1016/j.mayocp.2016.06.024


Author Gutierrez-Gutierrez, Belen
Salamanca, Elena
de Cueto, Marina
Hsueh, Po-Ren
Viale, Pierluigi
Ramon Pano-Pardo, Jose
Venditti, Mario
Tumbarello, Mario
Daikos, George
Pintado, Vicente
Doi, Yohei
Francisco Tuon, Felipe
Karaiskos, Ilias
Machuca, Isabel
Schwaber, Mitchell J.
Azap, Ozlem Kurt
Souli, Maria
Roilides, Emmanuel
Pournaras, Spyros
Akova, Murat
Perez, Federico
Bermejo, Joaquin
Oliver, Antonio
Almela, Manel
Lowman, Warren
Almirante, Benito
Bonomo, Robert A.
Carmeli, Yehuda
Paterson, David L.
Pascual, Alvaro
Rodriguez-Bano, Jesus
Title A predictive model of mortality in patients with bloodstream infections due to carbapenemase-producing enterobacteriaceae
Journal name Mayo Clinic Proceedings   Check publisher's open access policy
ISSN 0025-6196
1942-5546
Publication date 2016-10-01
Sub-type Article (original research)
DOI 10.1016/j.mayocp.2016.06.024
Open Access Status Not yet assessed
Volume 91
Issue 10
Start page 1362
End page 1371
Total pages 10
Place of publication New York, NY, United States
Publisher Elsevier
Collection year 2017
Language eng
Formatted 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.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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