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

• Autor(a) principal: Elenapérez'nadales
• Data de Publicação: 2019
• Outros Autores: Ranganathan n. Iyer, z. Koçak Tufan, e. Kazak, m. David, e. Lease, n. Nestorova, g. Cornaglia, m. Akova, Seema Metha, Elisa Grazia Calvi, E.m. Seminari, Maristela Pinheiro Freire, j. Carratalá, a. Domínguez, e. Cordero, J.a. Lepe, m. Montejo, e. Merino de Lucas, B.m. Eriksson, c. Van Delden, o. Manuel, h. Arslan, Mario Tumbarello, Marco Falcone, Mario Fernández'ruiz, José María Costa'mateo, Meenakshi m. Rana, Tania Mara Varejão Strabelli, Mical Paul, Belén Gutiérrez'gutiérrez, 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, Alejandra m. Natera, Paolo Antonio Grossi, Fabio Soldani, Filiz Gunseren, Nina Nestorova, Álvaro Pascual, Luis Martínez'martínez, José María Aguado, Jesús Rodríguez'baño, Julián Torre'cisneros, A.t. Wan Song, Edson Abdala, 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, Maira Reina Magalhães, p. Del Giacomo, g. Tiseo, j. Lora'tamayo, r San'juan, i. Gracia'ahufinger, j. Castón, Y.a. Ruiz, D.r. Altman, S.v. Campos, n. Bar'sinai, Alessandra Mularoni, f. Koppel, f. Arnaiz de Las Revillas Almajano, c. González Rico, m. Fernández Martínez, P.h.o. Mourão, F.a. Neves, Janita Ferreira, a. Pyrpasopoulou, e. Iosifidis, i. Romiopoulos, Francesco Monaco, M.v. Minero, c Sánchez'carrillo, s. Lardo, j. Coussement, m. Dodémont, k. Jiayun, p. Martín'dávila, j. Fortún, m. Almela, a. Moreno, Ligia Camera Pierrotti, l. Linares, D.d. Gasperina, M.l. Balsamo, c Rovelli, e. Concia, s. Chiesi, D.n. Salerno, d. Ogunc, b. Pilmis
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: http://hdl.handle.net/1843/55714; https://orcid.org/0000-0003-0848-3740
• topic: Antibiotic drug resistance; Clinical research/practice; Infection and infectious agents-bacterial; Infectious disease; Organ transplantation in general; Farmacorresistência Fúngica; Pesquisa em Enfermagem Clínica; Infectologia; Transplante de orgãos

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 multina tional, 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 fol lowing 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 operat ing 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 combi nation 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) mortal ity risk strata. A score-based algorithm is provided for therapy guidance.