@article{10902/18942,
year = {2020},
month = {6},
url = {http://hdl.handle.net/10902/18942},
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.},
organization = {This work was supported by Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de  Investigación  Cooperativa,  Ministerio  de  Ciencia,  Innovación  y Universidades, Spanish Network for Research in Infectious Diseases [REIPI  RD16/0016/0008;  RD16/0016/0001,  RD16/0016/0002, RD16/0016/00010] - co-financed by European Development Regional Fund “A way to achieve Europe”, Operative program Intelligent Growth 2014-2020;  ESCMID  Study  Group  for  Infections  in  Compromised Hosts  [ESGICH  grant  to  JMA];  Sociedad  Andaluza  de  Trasplante de Órgano Sólido [SATOT grant to LMM]; ESCMID Study Group for Bloodstream  Infections  and  Sepsis  (ESGBIS);  and  ESCMID  Study Group for Antimicrobial Resistance Surveillance (ESGARS)},
publisher = {Wiley Periodicals Inc.},
publisher = {Am J Transplant. 2020 ;20:1629-1641.},
title = {Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia},
author = {Pérez-Nadales, Elena and Gutiérrez-Gutiérrez, Belén and Natera, Alejandra M. and Abdala, Edson and Magalhães, Maira Reina and Mularoni, Alessandra and Monaco, Francesco and Camera Pierrotti, Ligia and Pinheiro Freire, Maristela and Iyer, Ranganathan N. and Metha, Seema and Grazia Calvi, Elisa and Tumbarello, Mario and Falcone, Marco and Fernández-Ruiz, Mario and Costa-Mateo, José María and Rana, Meenakshi M. and Varejão Strabelli, Tania Mara and Paul, Mical and Fariñas Álvarez, María del Carmen},
}