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: | |
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Data de Publicação: | 2019 |
Outros Autores: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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 |
Resumo: | 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. |
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2023-07-03T23:01:37Z2023-07-03T23:01:37Z201991629164110.1111/ajt.1576916006135http://hdl.handle.net/1843/55714https://orcid.org/0000-0003-0848-3740Treatment 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.engUniversidade Federal de Minas GeraisUFMGBrasilMED - DEPARTAMENTO DE PROPEDÊUTICA COMPLEMENTARAmerican Journal of TransplantationFarmacorresistência FúngicaPesquisa em Enfermagem ClínicaInfectologiaTransplante de orgãosAntibiotic drug resistanceClinical research/practiceInfection and infectious agents-bacterialInfectious diseaseOrgan transplantation in generalPredictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopeniainfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://www.sciencedirect.com/science/article/pii/S1600613522223624?via%3DihubElenapérez'nadalesRanganathan n. Iyerz. Koçak Tufane. Kazakm. Davide. Leasen. Nestorovag. Cornagliam. AkovaSeema MethaElisa Grazia CalviE.m. SeminariMaristela Pinheiro Freirej. Carrataláa. Domíngueze. CorderoJ.a. Lepem. Montejoe. Merino de LucasB.m. Erikssonc. Van Deldeno. Manuelh. ArslanMario TumbarelloMarco FalconeMario Fernández'ruizJosé María Costa'mateoMeenakshi m. RanaTania Mara Varejão StrabelliMical PaulBelén Gutiérrez'gutiérrezMaría Carmen FariñasWanessa Trindade ClementeEmmanuel RoilidesPatricia Muñoz GarcíaLaurent DewispelaereBelén LoechesWarren LowmanBan Hock TanRosa Escudero'sánchezMarta Bodro MarimontAlejandra m. NateraPaolo Antonio GrossiFabio SoldaniFiliz GunserenNina NestorovaÁlvaro PascualLuis Martínez'martínezJosé María AguadoJesús Rodríguez'bañoJulián Torre'cisnerosA.t. Wan SongEdson Abdalaw. AndrausL.a. Carneiro D'albuquerquee. David'netof. Jota de Paulaf. Rossid. Ostranderr. Averym. RizziA.r. Lositof. RaffaelliMaira Reina Magalhãesp. Del Giacomog. Tiseoj. Lora'tamayor San'juani. Gracia'ahufingerj. CastónY.a. RuizD.r. AltmanS.v. Camposn. Bar'sinaiAlessandra Mularonif. Koppelf. Arnaiz de Las Revillas Almajanoc. González Ricom. Fernández MartínezP.h.o. MourãoF.a. NevesJanita Ferreiraa. Pyrpasopouloue. Iosifidisi. RomiopoulosFrancesco MonacoM.v. Mineroc Sánchez'carrillos. Lardoj. Coussementm. Dodémontk. Jiayunp. Martín'dávilaj. Fortúnm. Almelaa. MorenoLigia Camera Pierrottil. LinaresD.d. GasperinaM.l. Balsamoc Rovellie. Concias. ChiesiD.n. Salernod. Oguncb. 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dc.title.pt_BR.fl_str_mv |
Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia |
title |
Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia |
spellingShingle |
Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia Elenapérez'nadales 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 |
title_short |
Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia |
title_full |
Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia |
title_fullStr |
Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia |
title_full_unstemmed |
Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia |
title_sort |
Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia |
author |
Elenapérez'nadales |
author_facet |
Elenapérez'nadales 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 |
author_role |
author |
author2 |
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 |
author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
dc.contributor.author.fl_str_mv |
Elenapérez'nadales 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 |
dc.subject.por.fl_str_mv |
Antibiotic drug resistance Clinical research/practice Infection and infectious agents-bacterial Infectious disease Organ transplantation in general |
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 |
dc.subject.other.pt_BR.fl_str_mv |
Farmacorresistência Fúngica Pesquisa em Enfermagem Clínica Infectologia Transplante de orgãos |
description |
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. |
publishDate |
2019 |
dc.date.issued.fl_str_mv |
2019 |
dc.date.accessioned.fl_str_mv |
2023-07-03T23:01:37Z |
dc.date.available.fl_str_mv |
2023-07-03T23:01:37Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/1843/55714 |
dc.identifier.doi.pt_BR.fl_str_mv |
10.1111/ajt.15769 |
dc.identifier.issn.pt_BR.fl_str_mv |
16006135 |
dc.identifier.orcid.pt_BR.fl_str_mv |
https://orcid.org/0000-0003-0848-3740 |
identifier_str_mv |
10.1111/ajt.15769 16006135 |
url |
http://hdl.handle.net/1843/55714 https://orcid.org/0000-0003-0848-3740 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.ispartof.none.fl_str_mv |
American Journal of Transplantation |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.publisher.initials.fl_str_mv |
UFMG |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
MED - DEPARTAMENTO DE PROPEDÊUTICA COMPLEMENTAR |
publisher.none.fl_str_mv |
Universidade Federal de Minas Gerais |
dc.source.none.fl_str_mv |
reponame:Repositório Institucional da UFMG instname:Universidade Federal de Minas Gerais (UFMG) instacron:UFMG |
instname_str |
Universidade Federal de Minas Gerais (UFMG) |
instacron_str |
UFMG |
institution |
UFMG |
reponame_str |
Repositório Institucional da UFMG |
collection |
Repositório Institucional da UFMG |
bitstream.url.fl_str_mv |
https://repositorio.ufmg.br/bitstream/1843/55714/1/License.txt https://repositorio.ufmg.br/bitstream/1843/55714/2/Predictors%20of%20mortality%20in%20solid%20organ%20transplant%20recepients%20with%20bloodstream%20infections%20pdfa.pdf |
bitstream.checksum.fl_str_mv |
fa505098d172de0bc8864fc1287ffe22 86c8fe1db3ab7e79a84a02627ee2bb21 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 |
repository.name.fl_str_mv |
Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG) |
repository.mail.fl_str_mv |
|
_version_ |
1803589394643288064 |