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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

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 multina-tional, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mor-tality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the fol-lowing 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 operat-ing 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 combi-nation 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) mortal-ity risk strata. A score-based algorithm is provided for therapy guidance.

 Fuente: Am J Transplant. 2020 ;20:1629-1641.

Editorial: Wiley Periodicals Inc.

 Fecha de publicación: 01/06/2020

Nº de páginas: 31

Tipo de publicación: Artículo de Revista

 DOI: doi.org/10.1111/ajt.15769

ISSN: 1600-6135,1600-6143

Url de la publicación: https://doi.org/10.1111/ajt.15769

Autores/as

PÉREZ-NADALES, ELENA

GUTIÉRREZ-GUTIÉRREZ, BELÉN

NATERA, ALEJANDRA M.

ABDALA, EDSON

MAGALHÃES, MAIRA REINA

MULARONI, ALESSANDRA

MONACO, FRANCESCO

CAMERA PIERROTTI, LIGIA

PINHEIRO FREIRE, MARISTELA

IYER, RANGANATHAN N.

METHA, SEEMA

GRAZIA CALVI, ELISA

TUMBARELLO, MARIO

FALCONE, MARCO

FERNÁNDEZ-RUIZ, MARIO

COSTA-MATEO, JOSÉ MARÍA

RANA, MEENAKSHI M.

VAREJÃO STRABELLI, TANIA MARA