Dataset Information

Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended-spectrum-?-lactamase-producing Enterobacteriaceae.

ABSTRACT: Bloodstream infections (BSIs) due to ESBL-producing Enterobacteriaceae (ESBL-E) are frequent yet outcome prediction rules for clinical use have not been developed. The objective was to define and validate a predictive risk score for 30?day mortality.A multinational retrospective cohort study including consecutive episodes of BSI due to ESBL-E was performed; cases were randomly assigned to a derivation cohort (DC) or a validation cohort (VC). The main outcome variable was all-cause 30?day mortality. A predictive score was developed using logistic regression coefficients for the DC, then tested in the VC.The DC and VC included 622 and 328 episodes, respectively. The final multivariate logistic regression model for mortality in the DC included age >50 years (OR?=?2.63; 95% CI: 1.18-5.85; 3 points), infection due to Klebsiella spp. (OR?=?2.08; 95% CI: 1.21-3.58; 2 points), source other than urinary tract (OR?=?3.6; 95% CI: 2.02-6.44; 3 points), fatal underlying disease (OR?=?3.91; 95% CI: 2.24-6.80; 4 points), Pitt score >3 (OR?=?3.04; 95?CI: 1.69-5.47; 3 points), severe sepsis or septic shock at presentation (OR?=?4.8; 95% CI: 2.72-8.46; 4 points) and inappropriate early targeted therapy (OR?=?2.47; 95% CI: 1.58-4.63; 2 points). The score showed an area under the receiver operating curve (AUROC) of 0.85 in the DC and 0.82 in the VC. Mortality rates for patients with scores of?

SUBMITTER: Palacios-Baena ZR

PROVIDER: S-EPMC5890678 | biostudies-literature | 2017 Mar

REPOSITORIES: biostudies-literature

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Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended-spectrum-β-lactamase-producing Enterobacteriaceae.

Palacios-Baena Zaira Raquel ZR Gutiérrez-Gutiérrez Belén B De Cueto Marina M Viale Pierluigi P Venditti Mario M Hernández-Torres Alicia A Oliver Antonio A Martínez-Martínez Luis L Calbo Esther E Pintado Vicente V Gasch Oriol O Almirante Benito B Antonio Lepe José J Pitout Johann J Akova Murat M Peña-Miralles Carmen C Schwaber Mitchell J MJ Tumbarello Mario M Tacconelli Evelina E Origüen Julia J Prim Nuria N Bou German G Giamarellou Helen H Bermejo Joaquín J Hamprecht Axel A Pérez Federico F Almela Manuel M Lowman Warren W Hsueh Po-Ren PR Navarro-San Francisco Carolina C Torre-Cisneros Julián J Carmeli Yehuda Y Bonomo Robert A RA Paterson David L DL Pascual Álvaro Á Rodríguez-Baño Jesús J

The Journal of antimicrobial chemotherapy 20170301 3

<h4>Background</h4>Bloodstream infections (BSIs) due to ESBL-producing Enterobacteriaceae (ESBL-E) are frequent yet outcome prediction rules for clinical use have not been developed. The objective was to define and validate a predictive risk score for 30 day mortality.<h4>Methods</h4>A multinational retrospective cohort study including consecutive episodes of BSI due to ESBL-E was performed; cases were randomly assigned to a derivation cohort (DC) or a validation cohort (VC). The main outcome va ...[more]

PMID: 28062685

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Project description:Plasmid-mediated AmpC beta-lactamase-producing (pAmpC) Enterobacteriaceae are increasing worldwide, difficult to identify and often confounded with extended-spectrum beta-lactamase (ESBL) producers. The low prevalence precludes routine universal admission screening. Therefore, we evaluated potential risk factors for carriage of pAmpC-producing Enterobacteriaceae that would allow targeted screening to improve yield and reduce cost.We performed a case control study at a tertiary care center from 1/2006 to 12/2010. Cases were adult patients in whom pAmpC-producing Enterobacteriaceae were isolated; controls were chosen among carriers of ESBL-producing Enterobacteriaceae. Both infected and colonized patients were included.Over five years, we identified 40 pAmpC producers in 39 patients among 16,247 screened consecutive isolates of Enterobacteriaceae. The pAmpC prevalence was low (0.25%), but more than 30% of pAmpC carriers received incorrect empirical antibiotic treatment. When compared with 39 ESBL controls, pAmpC carriage was associated with clinically confirmed infections in 74% (versus 51%) (p=0.035), mainly of the urinary tract, previous antibiotic exposure in 63% (versus 36%) (p=0.035) and carriage of a nasogastric tube in 23% (versus 0%) (p=0.002). In the multivariate regression analysis only clinically confirmed infections remained significantly associated with pAmpC carriage (OR 1.44 (95%CI 1.15-2.57)). No other clinical and blood test-associated risk factor allowed discrimination of pAmpC-carrying patients from ESBL controls. The type of acquisition - nosocomial versus community-acquired - was also non-informative for resistance type, as 46% of pAmpC- and 44% of ESBL-producing Enterobacteriaceae were community-acquired.This study could not identify a clinical profile that would allow targeted screening for pAmpC-producing Enterobacteriaceae when compared to ESBL carriers. Because empiric antimicrobial therapy was inappropriate in more than 30%, rapid identification of pAmpC carriers is needed. New microbiological methods are therefore required to simplify rapid and reliable detection of pAmpC carriers.

Dataset Information

Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended-spectrum-?-lactamase-producing Enterobacteriaceae.

Publications

Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended-spectrum-β-lactamase-producing Enterobacteriaceae.

Similar Datasets

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