Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia
Por:
Perez-Nadales, E, Gutierrez-Gutierrez, B, Natera, A, Abdala, E, Magalhaes, M, Mularoni, A, Monaco, F, Pierrotti, L, Freire, M, Iyer, R, Steinke, S, Calvi, E, Tumbarello, M, Falcone, M, Fernandez-Ruiz, M, Costa-Mateo, J, Rana, M, Strabelli, T, Paul, M, Farinas, M, Clemente, W, Roilides, E, Munoz, P, Dewispelaere, L, Loeches, B, Lowman, W, Tan, B, Escudero-Sanchez, R, Bodro, M, Grossi, P, Soldani, F, Gunseren, F, Nestorova, N, Pascual, A, Martinez-Martinez, L, Aguado, J, Rodriguez-Bano, J, Torre-Cisneros, J, Song, A, Andraus, W, D'Albuquerque, L, David-Neto, E, de Paula, F, Rossi, F, Ostrander, D, Avery, R, Rizzi, M, Losito, A, Raffaelli, F, Del Giacomo, P, Tiseo, G, Lora-Tamayo, J, San-Juan, R, Gracia-Ahufinger, I, Caston, J, Ruiz, Y, Altman, D, Campos, S, Bar-Sinai, N, Koppel, F, Almajano, F, Rico, C, Martinez, M, Mourao, P, Neves, F, Ferreira, J, Pyrpasopoulou, A, Iosifidis, E, Romiopoulos, I, Minero, M, Sanchez-Carrillo, C, Lardo, S, Coussement, J, Dodemont, M, Jiayun, K, Martin-Davila, P, Fortun, J, Almela, M, Moreno, A, Linares, L, Gasperina, D, Balsamo, M, Rovelli, C, Concia, E, Chiesi, S, Salerno, D, Ogunc, D, Pilmis, B, Seminari, E, Carratala, J, Dominguez, A, Cordero, E, Lepe, J, Montejo, M, de Lucas, E, Eriksson, B, van Delden, C, Manuel, O, Arslan, H, Tufan, Z, Kazak, E, David, M, Lease, E, Cornaglia, G, Akova, M, REIPI INCREMENT-SOT Investigators, Swiss Transplant Cohort Study and ESGARS-ESCMID Study Grp Antimicrob
Publicada:
1 jun 2020
Ahead of Print:
1 feb 2020
Resumen:
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.
Filiaciones:
Perez-Nadales, E:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Cordoba, Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain
Gutierrez-Gutierrez, B:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Seville, Inst Biomed Sevilla, Hosp Univ Virgen Macarena,Dept Med, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Natera, A:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Cordoba, Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain
Abdala, E:
Univ Sao Paulo, Fac Med, Sao Paulo, Brazil
Magalhaes, M:
Univ Sao Paulo, Fac Med, Sao Paulo, Brazil
Mularoni, A:
IRCCS ISMETT, Palermo, Italy
Monaco, F:
IRCCS ISMETT, Palermo, Italy
Pierrotti, L:
Univ Sao Paulo, Hosp Clin, Med Sch, Sao Paulo, Brazil
Freire, M:
Univ Sao Paulo, Hosp Clin, Med Sch, Sao Paulo, Brazil
Iyer, R:
Global Hosp, Hyderabad, India
Steinke, S:
Johns Hopkins Univ, Sch Med, Baltimore, MD USA
Calvi, E:
ASST Papa Giovanni XXIII, Bergamo, Italy
Tumbarello, M:
Fdn Policlin Univ Agostino Gemelli IRCCS, Rome, Italy
Falcone, M:
Univ Pisa, Dept Clin & Expt Med, Pisa, Italy
Fernandez-Ruiz, M:
Univ Complutense, Hosp Univ 12 Octubre, Inst Invest Hosp 12 Octubre Imas12, Unit Infect Dis, Madrid, Spain
Costa-Mateo, J:
Univ Cordoba, Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba, Unidad Enfermedades Infecciosas, Cordoba, Spain
Rana, M:
Icahn Sch Med Mt Sinai, New York, NY 10029 USA
Strabelli, T:
Univ Sch Med, Heart Inst Sao Paulo, Sao Paulo, Brazil
Paul, M:
Rambam Hlth Care Campus, Infect Dis Inst, Haifa, Israel
Technion Israel Fac Technol, Fac Med, Haifa, Israel
Farinas, M:
Univ Cantabria, Hosp Univ Marques de Valdecilla, Infect Dis Unit, Santander, Spain
Clemente, W:
Univ Fed Minas Gerais, Fac Med, Liver Transplantat Program, Hosp Clin, Belo Horizonte, MG, Brazil
Roilides, E:
Aristotle Univ Thessaloniki, Hippokrat Hosp, Sch Hlth Sci, Infect Dis Unit, Thessaloniki, Greece
Aristotle Univ Thessaloniki, Hippokrat Hosp, Sch Hlth Sci, Dept Pediat 3, Thessaloniki, Greece
Munoz, P:
Hosp Gen Univ Gregorio Maranon, Serv Microbiol Clin & Enfermedades Infecciosas, Madrid, Spain
Univ Complutense Madrid, Fac Med, Inst Invest Sanitaria Gregorio Maranon, CIBER Enfermedades Resp CIBERES CB06 06 0058, Madrid, Spain
Dewispelaere, L:
Univ Libre Bruxelles, Dept Microbiol, CUB Hop Erasme, Brussels, Belgium
Loeches, B:
Hosp La Paz, Infect Dis Unit, Madrid, Spain
Lowman, W:
Univ Witwatersrand, Fac Hlth Sci, Wits Donald Gordon Med Ctr, Vermaak & Partners Pathcare, Johannesburg, South Africa
Tan, B:
Singapore Gen Hosp, Dept Infect Dis, Singapore, Singapore
Escudero-Sanchez, R:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Ramon y Cajal Univ Hosp, Madrid, Spain
Bodro, M:
Univ Barcelona, Hosp Clin IDIBAPS, Infect Dis Dept, Barcelona, Spain
Grossi, P:
Univ Insubria, Varese, Italy
Soldani, F:
Azienda Osped Univ Integrata Verona, Dept Med, Infect Dis Unit, Verona, Italy
Gunseren, F:
Akdeniz Univ Hosp, Dept Infect Dis, Antalya, Turkey
Nestorova, N:
Mater Dei Hosp, Msida, Malta
Pascual, A:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Seville, Inst Biomed Sevilla, Hosp Univ Virgen Macarena,Dept Med, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Martinez-Martinez, L:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Cordoba, Hosp Univ Reina Sofia, IMIBIC, Unidad Gest Clin Microbiol, Cordoba, Spain
Aguado, J:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Complutense, Hosp Univ 12 Octubre, Inst Invest Hosp 12 Octubre Imas12, Unit Infect Dis, Madrid, Spain
Rodriguez-Bano, J:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Seville, Inst Biomed Sevilla, Hosp Univ Virgen Macarena,Dept Med, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain
Torre-Cisneros, J:
ISCIII, Spanish Network Res Infect Dis REIPI, Madrid, Spain
Univ Cordoba, Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba, Unidad Enfermedades Infecciosas, Cordoba, Spain
Song, A:
Univ Sao Paulo, Fac Med, Sao Paulo, Brazil
Andraus, W:
Univ Sao Paulo, Fac Med, Sao Paulo, Brazil
D'Albuquerque, L:
Univ Sao Paulo, Fac Med, Sao Paulo, Brazil
David-Neto, E:
Univ Sao Paulo, Hosp Clin, Med Sch, Dept Urol,Renal Transplantat Unit, Sao Paulo, Brazil
de Paula, F:
Univ Sao Paulo, Hosp Clin, Med Sch, Dept Urol,Renal Transplantat Unit, Sao Paulo, Brazil
Rossi, F:
Univ Sao Paulo, Med Sch, Dept Microbiol, Div Cent Lab,Hosp Clin Complex, Sao Paulo, Brazil
Ostrander, D:
Johns Hopkins Univ, Sch Med, Div Infect Dis, Baltimore, MD 21218 USA
Avery, R:
Johns Hopkins Univ, Sch Med, Div Infect Dis, Baltimore, MD 21218 USA
Rizzi, M:
ASST Papa Giovanni XXIII, Infect Dis Unit, Bergamo, Italy
Losito, A:
Fdn Policlin Univ Agostino Gemelli IRCCS, Rome, Italy
Raffaelli, F:
Fdn Policlin Univ Agostino Gemelli IRCCS, Rome, Italy
Del Giacomo, P:
Fdn Policlin Univ Agostino Gemelli IRCCS, Rome, Italy
Tiseo, G:
Policlin Umberto 1, Rome, Italy
Lora-Tamayo, J:
Univ Complutense, Hosp Univ 12 Octubre, Inst Invest Hosp 12 Octubre, Unit Infect Dis, Madrid, Spain
San-Juan, R:
Univ Complutense, Hosp Univ 12 Octubre, Inst Invest Hosp 12 Octubre, Unit Infect Dis, Madrid, Spain
Gracia-Ahufinger, I:
Univ Cordoba, Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba, Cordoba, Spain
Caston, J:
Univ Cordoba, Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba, Cordoba, Spain
Ruiz, Y:
Univ Cordoba, Hosp Univ Reina Sofia, Inst Maimonides Invest Biomed Cordoba, Cordoba, Spain
Altman, D:
Icahn Sch Med Mt Sinai, New York, NY 10029 USA
Campos, S:
Univ Sao Paulo, Sch Med, Heart Inst, Sao Paulo, SP, Brazil
Bar-Sinai, N:
Technion Israel Fac Technol, Fac Med, Haifa, Israel
Koppel, F:
Rambam Hlth Care Campus, Infect Dis Inst, Haifa, Israel
Almajano, F:
Marques de Valdecilla Univ Hosp, Infect Dis Unit, Santander, Spain
Rico, C:
Marques de Valdecilla Univ Hosp, Infect Dis Unit, Santander, Spain
Martinez, M:
Marques de Valdecilla Univ Hosp, Microbiol Serv, Santander, Spain
Mourao, P:
Univ Fed Minas Gerais, Infect Control & Hosp Epidemiol, Hosp Clin, Belo Horizonte, MG, Brazil
Neves, F:
Univ Fed Minas Gerais, Infect Control & Hosp Epidemiol, Hosp Clin, Belo Horizonte, MG, Brazil
Ferreira, J:
Univ Fed Minas Gerais, Infect Control & Hosp Epidemiol, Hosp Clin, Belo Horizonte, MG, Brazil
Pyrpasopoulou, A:
Aristotle Univ Thessaloniki, Hippokrat Hosp, Sch Hlth Sci, Infect Dis Unit, Thessaloniki, Greece
Iosifidis, E:
Aristotle Univ Thessaloniki, Hippokrat Hosp, Sch Hlth Sci, Infect Dis Unit, Thessaloniki, Greece
Romiopoulos, I:
Aristotle Univ Thessaloniki, Hippokrat Hosp, Sch Hlth Sci, Infect Dis Unit, Thessaloniki, Greece
Minero, M:
Hosp Gen Univ Gregorio Maranon, Serv Microbiol Clin & Enfermedades Infecciosas, Madrid, Spain
Inst Invest Sanitaria Gregorio Maranon, Madrid, Spain
Sanchez-Carrillo, C:
Hosp Gen Univ Gregorio Maranon, Serv Microbiol Clin & Enfermedades Infecciosas, Madrid, Spain
Inst Invest Sanitaria Gregorio Maranon, Madrid, Spain
Lardo, S:
IRCCS Roma, Ist Nazl Malattie Infett L Spallanzani, Rome, Italy
Coussement, J:
Univ Libre Bruxelles, Dept Microbiol, CUB Hop Erasme, Brussels, Belgium
Dodemont, M:
Univ Libre Bruxelles, Dept Microbiol, CUB Hop Erasme, Brussels, Belgium
Jiayun, K:
Singapore Gen Hosp, Dept Infect Dis, Singapore, Singapore
Martin-Davila, P:
Ramon y Cajal Univ Hosp, Madrid, Spain
Fortun, J:
Ramon y Cajal Univ Hosp, Madrid, Spain
Almela, M:
Univ Barcelona, Hosp Clin IDIBAPS, Barcelona, Spain
Moreno, A:
Univ Barcelona, Hosp Clin IDIBAPS, Barcelona, Spain
Linares, L:
Univ Barcelona, Hosp Clin IDIBAPS, Barcelona, Spain
Gasperina, D:
Univ Insubria, Varese, Italy
Balsamo, M:
Univ Insubria, Varese, Italy
Rovelli, C:
Univ Insubria, Varese, Italy
Concia, E:
Azienda Osped Univ Integrata Verona, Dept Med, Infect Dis Unit, Verona, Italy
Chiesi, S:
Azienda Osped Univ Integrata Verona, Dept Med, Infect Dis Unit, Verona, Italy
Salerno, D:
Azienda Osped Univ Integrata Verona, Dept Med, Infect Dis Unit, Verona, Italy
Ogunc, D:
Akdeniz Univ Hosp, Dept Clin Microbiol, Antalya, Turkey
Pilmis, B:
Univ Paris 05, Hop Necker Enfants Malad, Paris, France
Seminari, E:
Fdn IRCCS Policlin San Matteo, Pavia, Italy
Carratala, J:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Dominguez, A:
Hosp Univ Bellvitge Barcelona, Barcelona, Spain
Cordero, E:
Hosp Univ Virgen del Rocio, Seville, Spain
Lepe, J:
Hosp Univ Virgen del Rocio, Seville, Spain
Montejo, M:
Hosp Univ Cruces, Bilbao, Spain
:
Hosp Gen Univ Alicante, Alicante, Spain
Eriksson, B:
Akad Hosp, Uppsala, Sweden
van Delden, C:
Swiss Transplant Cohort Study, Zurich, Switzerland
Manuel, O:
Swiss Transplant Cohort Study, Zurich, Switzerland
Arslan, H:
Baskent Univ, Sch Med, Ankara, Turkey
Tufan, Z:
Yildirim Beyazit Univ, Ataturk T&R Hosp, Ankara, Turkey
Kazak, E:
Uludag Univ, Bursa, Turkey
David, M:
Univ Hosp Birmingham NHS Trust, Birmingham, W Midlands, England
Lease, E:
Univ Washington, Seattle, WA 98195 USA
Akova, M:
Hacettepe Univ, Sch Med Sihhiye, Dept Infect Dis, Ankara, Turkey
Green Accepted
|