OPEN IN READ APP
JOURNAL ARTICLE

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

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 Metha, Elisa Grazia Calvi, Mario Tumbarello, Marco Falcone, Mario Fernández-Ruiz, José María Costa-Mateo, Meenakshi M Rana, Tania Mara Varejão Strabelli, Mical Paul, María Carmen Fariñas, Wanessa Trindade Clemente, Emmanuel Roilides, Patricia Muñoz García, Laurent Dewispelaere, Belén Loeches, Warren Lowman, Ban Hock Tan, Rosa Escudero-Sánchez, Marta Bodro Marimont, Paolo Antonio Grossi, Fabio Soldani, Filiz Gunseren, Nina Nestorova, Álvaro Pascual, Luis Martínez-Martínez, José María Aguado, Jesús Rodríguez-Baño, Julián Torre-Cisneros
American Journal of Transplantation 2019 December 31
31891235
Treatment of carbapenemase-producing Enterobacterales bloodstream infections (CPE-BSI) in solid-organ transplant recipients (SOT) is challenging. The objective of this study was to develop a specific score to predict mortality in SOT recipients with CPE-BSI. 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% CI 0.76-0.88) and classified patients into three 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 versus combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted HR 2.82, 95% CI 1.13-7.06, P=0.03) and high (HR 9.93, 95% CI 2.08-47.40, P=0.004) mortality risk strata. A score-based algorithm is provided for therapy guidance.

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Available on the App Store

Available on the Play Store
Remove bar
Read by QxMD icon Read
31891235
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"