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. 2023 Jan 20;12(2):226.
doi: 10.3390/antibiotics12020226.

Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation

Fabián Herrera  1 , Diego Torres  1 , Ana Laborde  2 , Lorena Berruezo  3 , Rosana Jordán  4 , Inés Roccia Rossi  5 , Alejandra Valledor  6 , Patricia Costantini  7 , Miguel Dictar  8 , Andrea Nenna  9 , María Laura Pereyra  10 , Sandra Lambert  11 , José Benso  12 , Fernando Poletta  1 , María Luz Gonzalez Ibañez  2 , Nadia Baldoni  3 , María José Eusebio  4 , Fiorella Lovano  5 , Laura Barcán  6 , Martín Luck  7 , Agustina Racioppi  8 , Lucas Tula  11 , Fernando Pasterán  13 , Alejandra Corso  13 , Melina Rapoport  13 , Federico Nicola  1 , María Cristina García Damiano  2 , Ruth Carbone  3 , Renata Monge  4 , Mariana Reynaldi  5 , Graciela Greco  6   12 , Marcelo Bronzi  7 , Sandra Valle  8 , María Laura Chaves  9 , Viviana Vilches  10 , Miriam Blanco  11 , Alberto Ángel Carena  1 ; Argentine Group for the Study of Bacteremia in Cancer and Stem Cell Transplant (ROCAS) Study
Affiliations

Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation

Fabián Herrera et al. Antibiotics (Basel). .

Abstract

Identifying the risk factors for carbapenem-resistant Enterobacterales (CRE) bacteremia in cancer and hematopoietic stem cell transplantation (HSCT) patients would allow earlier initiation of an appropriate empirical antibiotic treatment. This is a prospective multicenter observational study in patients from 12 centers in Argentina, who presented with cancer or hematopoietic stem-cell transplant and developed Enterobacterales bacteremia. A multiple logistic regression model identified risk factors for CRE bacteremia, and a score was developed according to the regression coefficient. This was validated by the bootstrap resampling technique. Four hundred and forty-three patients with Enterobacterales bacteremia were included: 59 with CRE and 384 with carbapenem-susceptible Enterobacterales (CSE). The risk factors that were identified and the points assigned to each of them were: ≥10 days of hospitalization until bacteremia: OR 4.03, 95% CI 1.88-8.66 (2 points); previous antibiotics > 7 days: OR 4.65, 95% CI 2.29-9.46 (2 points); current colonization with KPC-carbapenemase-producing Enterobacterales: 33.08, 95% CI 11.74-93.25 (5 points). With a cut-off of 7 points, a sensitivity of 35.59%, specificity of 98.43%, PPV of 77.7%, and NPV of 90.9% were obtained. The overall performance of the score was satisfactory (AUROC of 0.85, 95% CI 0.80-0.91). Finally, the post-test probability of CRE occurrence in patients with none of the risk factors was 1.9%, which would virtually rule out the presence of CRE bacteremia.

Keywords: Enterobacterales; bacteremia; cancer; score.

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Conflict of interest statement

Fabián Herrera received speaker honoraria from MSD and Pfizer and a research and educational grant from Pfizer. Fernando Pasterán received speaker honoraria from MSD and Pfizer. Sandra Lambert received speaker honoraria from Pfizer. The rest of the authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Etiology of Enterobacterales bacteremia. Differences between carbapenem-susceptible Enterobacterales (CSE) and carbapenem-resistant Enterobacterales (CRE) isolates.
Figure 2
Figure 2
Resistance mechanisms of Enterobacterales. Proportion of extended-spectrum β-lactamases (ESBL) and Amp-C producers in carbapenem-susceptible Enterobacterales (CSE) isolates. Proportion of blaKPC and blaOXA-48 in carbapenem-resistant Enterobacterales (CRE) isolates.
See this image and copyright information in PMC

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