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

AuthorsPérez-Nadales, Elena; Gutiérrez-Gutiérrez, Belén; Natera, Alejandra M.; Abdala, Edson; Reina Magalhães, Maira; Mularoni, Alessandra; Monaco, Francesco; Camera Pierrotti, Ligia; Pinheiro Freire, Maristela; Iyer, Ranganathan N.; Mehta Steinke, Seema; Grazia Calvi, Elisa; Tumbarello, Mario; Falcone, Marco; Fernández-Ruiz, Mario; Costa-Mateo, Jose M.; Rana, Meenakshi M.; Mara Varejao Strabelli, Tania; Paul, Mical; Fariñas, María del Carmen; Trindade Clemente, Wanessa; Roilides, Emmanuel; Muñoz García, Patricia; Dewispelaere, Laurent; Loeches, Belén; Lowman, Warren; Hock Tan, Ban; Escudero Sánchez, Rosa; Bodro, Marta; Grossi, Paolo A.; Soldani, Fabio; Gunseren, Filiz; Nestorova, Nina; Pascual, Álvaro; Martínez-Martínez, Luis; Aguado, José María; Aguado, José María; Torre-Cisneros, Julián
KeywordsAntibiotic drug resistance
Clinical research/practice
Infection and infectious agents - bacterial
Infectious disease
Organ transplantation in general
Issue DateJun-2020
PublisherJohn Wiley & Sons
CitationAmerican Journal of Transplantation 20(6): 1629-1641 (2020)
AbstractTreatment 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.
Publisher version (URL)https://doi.org/10.1111/ajt.15769
Identifiersdoi: 10.1111/ajt.15769
e-issn: 1600-6143
issn: 1600-6135
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