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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.
Pérez-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; María Costa-Mateo, José; Rana, Meenakshi M; Mara Varejão Strabelli, Tania; Paul, Mical; Carmen Fariñas, María; Clemente, Wanessa Trindade; Roilides, Emmanuel; Muñoz, Patricia; Dewispelaere, Laurent; Loeches, Belén; Lowman, Warren; Tan, Ban Hock; Escudero-Sánchez, Rosa; Bodro, Marta; Antonio Grossi, Paolo; Soldani, Fabio; Gunseren, Filiz; Nestorova, Nina; Pascual, Álvaro; Martínez-Martínez, Luis; Aguado, José María; Rodríguez-Baño, Jesús; Torre-Cisneros, Julián.
Afiliación
  • Pérez-Nadales E; Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain.
  • Gutiérrez-Gutiérrez B; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
  • Natera AM; Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain.
  • Abdala E; Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla, Seville, Spain.
  • Reina Magalhães M; Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain.
  • Mularoni A; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
  • Monaco F; Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
  • Camera Pierrotti L; Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
  • Pinheiro Freire M; IRCCS ISMETT, Palermo, Italy.
  • Iyer RN; IRCCS ISMETT, Palermo, Italy.
  • Mehta Steinke S; Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
  • Grazia Calvi E; Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil.
  • Tumbarello M; Global Hospitals, Hyderabad, India.
  • Falcone M; School of Medicine, Johns Hopkins University, Baltimore, Maryland.
  • Fernández-Ruiz M; ASST Papa Giovanni XXIII, Bergamo, Italy.
  • María Costa-Mateo J; Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
  • Rana MM; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
  • Mara Varejão Strabelli T; Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Hospital "12 de Octubre" (imas12), Universidad Complutense, Madrid, Spain.
  • Paul M; Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba, Universidad de Córdoba, Córdoba, Spain.
  • Carmen Fariñas M; Icahn School of Medicine at Mount Sinai, New York, New York.
  • Clemente WT; Heart Institute of São Paulo, University School of Medicine, Sao Paulo, Brazil.
  • Roilides E; Infectious Diseases Institute, Rambam Health Care Campus and Faculty of Medicine, Technion - Israel Faculty of Technology, Haifa, Israel.
  • Muñoz P; Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain.
  • Dewispelaere L; Faculty of Medicine, Liver Transplantation Program, Hospital das Clínicas -Federal University of Minas Gerais, Belo Horizonte, Brazil.
  • Loeches B; Infectious Diseases Unit and 3rd, Department of Pediatrics, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece.
  • Lowman W; Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  • Tan BH; Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
  • Escudero-Sánchez R; Department of Microbiology, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
  • Bodro M; Infectious Diseases Unit, Hospital La Paz, Madrid, Spain.
  • Antonio Grossi P; Wits Donald Gordon Medical Centre, Vermaak & Partners/Pathcare, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Soldani F; Department of Infectious Diseases, Singapore General Hospital, Singapore.
  • Gunseren F; Spanish Network for Research in Infectious Diseases (REIPI), ISCIII, Spain.
  • Nestorova N; Ramón y Cajal University Hospital, Madrid, Spain.
  • Pascual Á; Infectious Diseases Department, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain.
  • Martínez-Martínez L; University of Insubria, Varese, Italy.
  • Aguado JM; Department of Medicine, Infectious Diseases Unit, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
  • Rodríguez-Baño J; Department of Infectious Diseases, Akdeniz University Hospital, Antalya, Turkey.
  • Torre-Cisneros J; Mater Dei Hospital, Msida, Malta.
Am J Transplant ; 2019 12 31.
Article en En | MEDLINE | ID: mdl-31891235
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.
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Texto completo: 1 Base de datos: MEDLINE Tipo de estudio: Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Am J Transplant Asunto de la revista: TRANSPLANTE Año: 2019 Tipo del documento: Article

Texto completo: 1 Base de datos: MEDLINE Tipo de estudio: Guideline / Observational_studies / Prognostic_studies / Risk_factors_studies Idioma: En Revista: Am J Transplant Asunto de la revista: TRANSPLANTE Año: 2019 Tipo del documento: Article