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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
Author(s) -
PérezNadales Elena,
GutiérrezGutiérrez 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,
FernándezRuiz Mario,
CostaMateo José María,
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,
Hock Tan Ban,
EscuderoSánchez Rosa,
Bodro Marta,
Antonio Grossi Paolo,
Soldani Fabio,
Gunseren Filiz,
Nestorova Nina,
Pascual Álvaro,
MartínezMartínez Luis,
Aguado JoséMaría,
RodríguezBaño Jesús,
TorreCisneros Julián
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15769
Subject(s) - medicine , hazard ratio , confidence interval , logistic regression , retrospective cohort study , cohort
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.