Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia

Mario Tumbarello, Elena Pérez-Nadales, Belén Gutiérrez-Gutiérrez, Alejandra M. Natera, Edson Abdala, Maira Reina Magalhães, Alessandra Mularoni, Francesco Monaco, Ligia Camera Pierrotti, Maristela Pinheiro Freire, Ranganathan N. Iyer, Seema Mehta Steinke, Elisa Grazia Calvi, Marco Falcone, Mario Fernández-Ruiz, José María Costa-Mateo, Meenakshi M. Rana, Tania Mara Varejão Strabelli, Mical Paul, María Carmen FariñasWanessa Trindade Clemente, Emmanuel Roilides, Patricia Muñoz, Laurent Dewispelaere, Belén Loeches, Warren Lowman, Ban Hock Tan, Rosa Escudero-Sánchez, Marta Bodro, Paolo Antonio Grossi, Fabio Soldani, Filiz Gunseren, Nina Nestorova, Álvaro Pascual, Luis Martínez-Martínez, Josémaría Aguado, Jesús Rodríguez-Baño, Julián Torre-Cisneros, A. T. Wan Song, W. Andraus, L. A. Carneiro D'Albuquerque, E. David-Neto, F. Jota De Paula, F. Rossi, D. Ostrander, R. Avery, M. Rizzi, A. R. Losito, F. Raffaelli, P. Del Giacomo, G. Tiseo, J. Lora-Tamayo, R. San-Juan, I. Gracia-Ahufinger, J. Castón

Risultato della ricerca: Contributo in rivistaArticolo in rivista

3 Citazioni (Scopus)

Abstract

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.
Lingua originaleEnglish
pagine (da-a)N/A-N/A
RivistaAmerican Journal of Transplantation
DOI
Stato di pubblicazionePubblicato - 2019

Keywords

  • antibiotic drug resistance
  • clinical research/practice
  • infection and infectious agents - bacterial
  • infectious disease
  • organ transplantation in general

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