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
Abstract 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.

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.

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.

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.
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
Institutional Status UQ

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