Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extendedspectrum- beta-lactamase-producing Enterobacteriaceae

Raquel Palacios-Baena, Zaira, Gutierrez-Gutierrez, Belen, De Cueto, Marina, Viale, Pierluigi, Venditti, Mario, Hernandez-Torres, Alicia, Oliver, Antonio, Martinez-Martinez, Luis, Calbo, Esther, Pintado, Vicente, Gasch, Oriol, Almirante, Benito, Antonio Lepe, Jose, Pitout, Johann, Akova, Murat, Pena-Miralles, Carmen, Schwaber, Mitchell J., Tumbarello, Mario, Tacconelli, Evelina, Origuen, Julia, Prim, Nuria, Bou, German, Giamarellou, Helen, Bermejo, Joaquin, Hamprecht, Axel, Perez, Federico, Almela, Manuel, Lowman, Warren, Hsueh, Po-Ren, Navarro-San Francisco, Carolina, Torre-Cisneros, Julian, Carmeli, Yehuda, Bonomo, Robert A., Paterson, David L., Pascual, Alvaro and Rodriguez-Bano, Jesus (2017) Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extendedspectrum- beta-lactamase-producing Enterobacteriaceae. Journal of Antimicrobial Chemotherapy, 72 3: 906-913. doi:10.1093/jac/dkw513


Author Raquel Palacios-Baena, Zaira
Gutierrez-Gutierrez, Belen
De Cueto, Marina
Viale, Pierluigi
Venditti, Mario
Hernandez-Torres, Alicia
Oliver, Antonio
Martinez-Martinez, Luis
Calbo, Esther
Pintado, Vicente
Gasch, Oriol
Almirante, Benito
Antonio Lepe, Jose
Pitout, Johann
Akova, Murat
Pena-Miralles, Carmen
Schwaber, Mitchell J.
Tumbarello, Mario
Tacconelli, Evelina
Origuen, Julia
Prim, Nuria
Bou, German
Giamarellou, Helen
Bermejo, Joaquin
Hamprecht, Axel
Perez, Federico
Almela, Manuel
Lowman, Warren
Hsueh, Po-Ren
Navarro-San Francisco, Carolina
Torre-Cisneros, Julian
Carmeli, Yehuda
Bonomo, Robert A.
Paterson, David L.
Pascual, Alvaro
Rodriguez-Bano, Jesus
Title Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extendedspectrum- beta-lactamase-producing Enterobacteriaceae
Journal name Journal of Antimicrobial Chemotherapy   Check publisher's open access policy
ISSN 0305-7453
1460-2091
Publication date 2017-03-01
Sub-type Article (original research)
DOI 10.1093/jac/dkw513
Open Access Status Not yet assessed
Volume 72
Issue 3
Start page 906
End page 913
Total pages 8
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Language eng
Subject 3004 Pharmacology
2736 Pharmacology (medical)
2725 Infectious Diseases
Abstract Background.: Bloodstream infections (BSIs) due to ESBL-producing Enterobacteriaceae (ESBL-E) are frequent yet outcome prediction rules for clinical use have not been developed. The objective was to define and validate a predictive risk score for 30 day mortality.
Formatted abstract
Background: Bloodstream infections (BSIs) due to ESBL-producing Enterobacteriaceae (ESBL-E) are frequent yet outcome prediction rules for clinical use have not been developed. The objective was to define and validate a predictive risk score for 30 day mortality.

Methods: A multinational retrospective cohort study including consecutive episodes of BSI due to ESBL-E was performed; cases were randomly assigned to a derivation cohort (DC) or a validation cohort (VC). The main outcome variable was all-cause 30 day mortality. A predictive score was developed using logistic regression coefficients for the DC, then tested in the VC.

Results: The DC and VC included 622 and 328 episodes, respectively. The final multivariate logistic regression model for mortality in the DC included age >50 years (OR = 2.63; 95% CI: 1.18–5.85; 3 points), infection due to Klebsiella spp. (OR = 2.08; 95% CI: 1.21–3.58; 2 points), source other than urinary tract (OR = 3.6; 95% CI: 2.02–6.44; 3 points), fatal underlying disease (OR = 3.91; 95% CI: 2.24–6.80; 4 points), Pitt score >3 (OR = 3.04; 95 CI: 1.69–5.47; 3 points), severe sepsis or septic shock at presentation (OR = 4.8; 95% CI: 2.72–8.46; 4 points) and inappropriate early targeted therapy (OR = 2.47; 95% CI: 1.58–4.63; 2 points). The score showed an area under the receiver operating curve (AUROC) of 0.85 in the DC and 0.82 in the VC. Mortality rates for patients with scores of < 11 and ≥11 were 5.6% and 45.9%, respectively, in the DC, and 5.4% and 34.8% in the VC.

Conclusions: We developed and validated an easy-to-collect predictive scoring model for all-cause 30 day mortality useful for identifying patients at high and low risk of mortality.
Keyword Hospital Admission
Bacteremia
Therapy
Metaanalysis
Management
Model
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID R01 AI072219
R01 AI063517
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
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Created: Mon, 17 Apr 2017, 01:00:48 EST by Web Cron on behalf of Learning and Research Services (UQ Library)