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Observational Study
. 2016 Oct;91(10):1362-1371.
doi: 10.1016/j.mayocp.2016.06.024.

A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae

Belén Gutiérrez-Gutiérrez  1 , Elena Salamanca  1 , Marina de Cueto  1 , Po-Ren Hsueh  2 , Pierluigi Viale  3 , José Ramón Paño-Pardo  4 , Mario Venditti  5 , Mario Tumbarello  6 , George Daikos  7 , Vicente Pintado  8 , Yohei Doi  9 , Felipe Francisco Tuon  10 , Ilias Karaiskos  11 , Isabel Machuca  12 , Mitchell J Schwaber  13 , Özlem Kurt Azap  14 , Maria Souli  15 , Emmanuel Roilides  16 , Spyros Pournaras  17 , Murat Akova  18 , Federico Pérez  19 , Joaquín Bermejo  20 , Antonio Oliver  21 , Manel Almela  22 , Warren Lowman  23 , Benito Almirante  24 , Robert A Bonomo  25 , Yehuda Carmeli  26 , David L Paterson  27 , Alvaro Pascual  28 , Jesús Rodríguez-Baño  29 ; Investigators from the REIPI/ESGBIS/INCREMENT Group
Collaborators, Affiliations
Observational Study

A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae

Belén Gutiérrez-Gutiérrez et al. Mayo Clin Proc. 2016 Oct.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] Mayo Clin Proc. 2016 Dec;91(12):1843. doi: 10.1016/j.mayocp.2016.11.002. Mayo Clin Proc. 2016. PMID: 27916160 No abstract available.

Abstract

Objective: To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE).

Patients and methods: A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score.

Results: The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar.

Conclusion: A validated score predictive of early mortality in patients with BSIs due to CPE was developed.

Trial registration: clinicaltrials.gov Identifier: NCT01 764490.

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