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. |
Publication Type | Journal Article |
Year of Publication | 2019 |
Authors | Pérez-Nadales, E., Gutiérrez-Gutiérrez B., Natera A. M., Abdala E., Magalhães M. Reina, Mularoni A., Monaco F., Pierrotti L. Camera, Freire M. Pinheiro, Iyer R. N., Steinke S. Mehta, Calvi E. Grazia, Tumbarello M., Falcone M., Fernández-Ruiz M., Costa-Mateo J. María, Rana M. M., Strabelli T. Mara Varej, Paul M., Fariñas M. Carmen, Clemente W. Trindade, Roilides E., Munoz P., Dewispelaere L., Loeches B., Lowman W., Tan B. Hock, Escudero-Sánchez R., Bodro M., Grossi P. Antonio, Soldani F., Gunseren F., Nestorova N., Pascual A., Martínez-Martínez L., Aguado J. María, Rodríguez-Baño J., & Torre-Cisneros J. |
Corporate Authors | REIPI/INCREMENT-SOT Investigators |
Journal | Am J Transplant |
Date Published | 2019 12 31 |
ISSN | 1600-6143 |
Abstract | 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. |
DOI | 10.1111/ajt.15769 |
Alternate Journal | Am J Transplant |
PubMed ID | 31891235 |
Grant List | / / ESCMID Study Group for Infections in Compromised Hosts (ESGICH) / International / / Sociedad Andaluza de Trasplante de Órgano Sólido (SATOT) / International / / Plan Nacional de I+D+i 2013-2016 / International / / Instituto de Salud Carlos III / International / / Subdirección General de Redes y Centros de Investigación Cooperativa / International / / Innovación y Universidades / International RD16/0016/0008 / / Spanish Network for Research in Infectious Diseases / International RD16/0016/0001 / / Spanish Network for Research in Infectious Diseases / International RD16/0016/0002 / / Spanish Network for Research in Infectious Diseases / International RD16/0016/00010 / / Spanish Network for Research in Infectious Diseases / International |