A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae

Belén Gutiérrez-Gutiérrez, Elena Salamanca, Marina de Cueto, Alvaro Pascual, Jesús Rodríguez-Baño, Po Ren Hsueh, Pierluigi Viale, José Ramón Paño-Pardo, Mario Venditti, Mario Tumbarello, George Daikos, Vicente Pintado, Yohei Doi, Felipe Francisco Tuon, Ilias Karaiskos, Isabel Machuca, Mitchell J. Schwaber, Özlem Kurt Azap, Maria Souli, Emmanuel RoilidesSpyros Pournaras, Murat Akova, Federico Pérez, Robert A. Bonomo, Joaquín Bermejo, Antonio Oliver, Manel Almela, Warren Lowman, Benito Almirante, Yehuda Carmeli, David L. Paterson, M. Falcone, A. Russo, H. Giamarellou, E. M. Trecarichi, A. R. Losito, E. García-Vázquez, A. Hernández, J. Gómez, E. Iosifidis, N. Prim, F. Navarro, B. Mirelis, J. Origüen, R. San Juan, M. Fernández-Ruiz, N. Larrosa, M. Puig-Asensio, J. M. Cisneros, J. Molina, V. González, V. Rucci, E. Ruiz de Gopegui, C. I. Marinescu, L. Martínez-Martínez, M. C. Fariñas, M. E. Cano, M. Gozalo, M. Mora-Rillo, C. Navarro-San Francisco, C. Peña, S. Gómez-Zorrilla, F. Tubau, A. Tsakris, O. Zarkotou, J. Pitout, D. Virmani, J. Torre-Cisneros, C. Natera, Helvaci, A. O. Sahin, R. Cantón, P. Ruiz, M. Bartoletti, M. Giannella, E. Taconelli, F. Riemenschneider, E. Calbo, C. Badia, M. Xercavins, E. Gasch, D. Fontanals, E. Jové

Research output: Contribution to journalArticle

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Abstract

Objective To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). Patients and Methods A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. Results The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. Conclusion A validated score predictive of early mortality in patients with BSIs due to CPE was developed. Trial Registration clinicaltrials.gov Identifier: NCT01 764490.

Original languageEnglish
Pages (from-to)1362-1371
Number of pages10
JournalMayo Clinic Proceedings
Volume91
Issue number10
DOIs
Publication statusPublished - 01-10-2016

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Enterobacteriaceae
Mortality
Infection
Logistic Models
ROC Curve
Biliary Tract
Secondary Prevention
Urinary Tract
Comorbidity
Shock
Sepsis
Cohort Studies
Retrospective Studies
carbapenemase
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Gutiérrez-Gutiérrez, B., Salamanca, E., de Cueto, M., Pascual, A., Rodríguez-Baño, J., Hsueh, P. R., ... Jové, E. (2016). A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae. Mayo Clinic Proceedings, 91(10), 1362-1371. https://doi.org/10.1016/j.mayocp.2016.06.024
Gutiérrez-Gutiérrez, Belén ; Salamanca, Elena ; de Cueto, Marina ; Pascual, Alvaro ; Rodríguez-Baño, Jesús ; Hsueh, Po Ren ; Viale, Pierluigi ; Paño-Pardo, José Ramón ; Venditti, Mario ; Tumbarello, Mario ; Daikos, George ; Pintado, Vicente ; Doi, Yohei ; Tuon, Felipe Francisco ; Karaiskos, Ilias ; Machuca, Isabel ; Schwaber, Mitchell J. ; Azap, Özlem Kurt ; Souli, Maria ; Roilides, Emmanuel ; Pournaras, Spyros ; Akova, Murat ; Pérez, Federico ; Bonomo, Robert A. ; Bermejo, Joaquín ; Oliver, Antonio ; Almela, Manel ; Lowman, Warren ; Almirante, Benito ; Carmeli, Yehuda ; Paterson, David L. ; Falcone, M. ; Russo, A. ; Giamarellou, H. ; Trecarichi, E. M. ; Losito, A. R. ; García-Vázquez, E. ; Hernández, A. ; Gómez, J. ; Iosifidis, E. ; Prim, N. ; Navarro, F. ; Mirelis, B. ; Origüen, J. ; San Juan, R. ; Fernández-Ruiz, M. ; Larrosa, N. ; Puig-Asensio, M. ; Cisneros, J. M. ; Molina, J. ; González, V. ; Rucci, V. ; Ruiz de Gopegui, E. ; Marinescu, C. I. ; Martínez-Martínez, L. ; Fariñas, M. C. ; Cano, M. E. ; Gozalo, M. ; Mora-Rillo, M. ; Navarro-San Francisco, C. ; Peña, C. ; Gómez-Zorrilla, S. ; Tubau, F. ; Tsakris, A. ; Zarkotou, O. ; Pitout, J. ; Virmani, D. ; Torre-Cisneros, J. ; Natera, C. ; Helvaci ; Sahin, A. O. ; Cantón, R. ; Ruiz, P. ; Bartoletti, M. ; Giannella, M. ; Taconelli, E. ; Riemenschneider, F. ; Calbo, E. ; Badia, C. ; Xercavins, M. ; Gasch, E. ; Fontanals, D. ; Jové, E. / A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae. In: Mayo Clinic Proceedings. 2016 ; Vol. 91, No. 10. pp. 1362-1371.
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title = "A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae",
abstract = "Objective To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). Patients and Methods A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. Results The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95{\%} CI, 0.74-0.85) in the DC and 0.80 (95{\%} CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. Conclusion A validated score predictive of early mortality in patients with BSIs due to CPE was developed. Trial Registration clinicaltrials.gov Identifier: NCT01 764490.",
author = "Bel{\'e}n Guti{\'e}rrez-Guti{\'e}rrez and Elena Salamanca and {de Cueto}, Marina and Alvaro Pascual and Jes{\'u}s Rodr{\'i}guez-Ba{\~n}o and Hsueh, {Po Ren} and Pierluigi Viale and Pa{\~n}o-Pardo, {Jos{\'e} Ram{\'o}n} and Mario Venditti and Mario Tumbarello and George Daikos and Vicente Pintado and Yohei Doi and Tuon, {Felipe Francisco} and Ilias Karaiskos and Isabel Machuca and Schwaber, {Mitchell J.} and Azap, {{\"O}zlem Kurt} and Maria Souli and Emmanuel Roilides and Spyros Pournaras and Murat Akova and Federico P{\'e}rez and Bonomo, {Robert A.} and Joaqu{\'i}n Bermejo and Antonio Oliver and Manel Almela and Warren Lowman and Benito Almirante and Yehuda Carmeli and Paterson, {David L.} and M. Falcone and A. Russo and H. Giamarellou and Trecarichi, {E. M.} and Losito, {A. R.} and E. Garc{\'i}a-V{\'a}zquez and A. Hern{\'a}ndez and J. G{\'o}mez and E. Iosifidis and N. Prim and F. Navarro and B. Mirelis and J. Orig{\"u}en and {San Juan}, R. and M. Fern{\'a}ndez-Ruiz and N. Larrosa and M. Puig-Asensio and Cisneros, {J. M.} and J. Molina and V. Gonz{\'a}lez and V. Rucci and {Ruiz de Gopegui}, E. and Marinescu, {C. I.} and L. Mart{\'i}nez-Mart{\'i}nez and Fari{\~n}as, {M. C.} and Cano, {M. E.} and M. Gozalo and M. Mora-Rillo and {Navarro-San Francisco}, C. and C. Pe{\~n}a and S. G{\'o}mez-Zorrilla and F. Tubau and A. Tsakris and O. Zarkotou and J. Pitout and D. Virmani and J. Torre-Cisneros and C. Natera and Helvaci and Sahin, {A. O.} and R. Cant{\'o}n and P. Ruiz and M. Bartoletti and M. Giannella and E. Taconelli and F. Riemenschneider and E. Calbo and C. Badia and M. Xercavins and E. Gasch and D. Fontanals and E. Jov{\'e}",
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Gutiérrez-Gutiérrez, B, Salamanca, E, de Cueto, M, Pascual, A, Rodríguez-Baño, J, Hsueh, PR, Viale, P, Paño-Pardo, JR, Venditti, M, Tumbarello, M, Daikos, G, Pintado, V, Doi, Y, Tuon, FF, Karaiskos, I, Machuca, I, Schwaber, MJ, Azap, ÖK, Souli, M, Roilides, E, Pournaras, S, Akova, M, Pérez, F, Bonomo, RA, Bermejo, J, Oliver, A, Almela, M, Lowman, W, Almirante, B, Carmeli, Y, Paterson, DL, Falcone, M, Russo, A, Giamarellou, H, Trecarichi, EM, Losito, AR, García-Vázquez, E, Hernández, A, Gómez, J, Iosifidis, E, Prim, N, Navarro, F, Mirelis, B, Origüen, J, San Juan, R, Fernández-Ruiz, M, Larrosa, N, Puig-Asensio, M, Cisneros, JM, Molina, J, González, V, Rucci, V, Ruiz de Gopegui, E, Marinescu, CI, Martínez-Martínez, L, Fariñas, MC, Cano, ME, Gozalo, M, Mora-Rillo, M, Navarro-San Francisco, C, Peña, C, Gómez-Zorrilla, S, Tubau, F, Tsakris, A, Zarkotou, O, Pitout, J, Virmani, D, Torre-Cisneros, J, Natera, C, Helvaci, Sahin, AO, Cantón, R, Ruiz, P, Bartoletti, M, Giannella, M, Taconelli, E, Riemenschneider, F, Calbo, E, Badia, C, Xercavins, M, Gasch, E, Fontanals, D & Jové, E 2016, 'A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae', Mayo Clinic Proceedings, vol. 91, no. 10, pp. 1362-1371. https://doi.org/10.1016/j.mayocp.2016.06.024

A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae. / Gutiérrez-Gutiérrez, Belén; Salamanca, Elena; de Cueto, Marina; Pascual, Alvaro; Rodríguez-Baño, Jesús; Hsueh, Po Ren; Viale, Pierluigi; Paño-Pardo, José Ramón; Venditti, Mario; Tumbarello, Mario; Daikos, George; Pintado, Vicente; Doi, Yohei; Tuon, Felipe Francisco; Karaiskos, Ilias; Machuca, Isabel; Schwaber, Mitchell J.; Azap, Özlem Kurt; Souli, Maria; Roilides, Emmanuel; Pournaras, Spyros; Akova, Murat; Pérez, Federico; Bonomo, Robert A.; Bermejo, Joaquín; Oliver, Antonio; Almela, Manel; Lowman, Warren; Almirante, Benito; Carmeli, Yehuda; Paterson, David L.; Falcone, M.; Russo, A.; Giamarellou, H.; Trecarichi, E. M.; Losito, A. R.; García-Vázquez, E.; Hernández, A.; Gómez, J.; Iosifidis, E.; Prim, N.; Navarro, F.; Mirelis, B.; Origüen, J.; San Juan, R.; Fernández-Ruiz, M.; Larrosa, N.; Puig-Asensio, M.; Cisneros, J. M.; Molina, J.; González, V.; Rucci, V.; Ruiz de Gopegui, E.; Marinescu, C. I.; Martínez-Martínez, L.; Fariñas, M. C.; Cano, M. E.; Gozalo, M.; Mora-Rillo, M.; Navarro-San Francisco, C.; Peña, C.; Gómez-Zorrilla, S.; Tubau, F.; Tsakris, A.; Zarkotou, O.; Pitout, J.; Virmani, D.; Torre-Cisneros, J.; Natera, C.; Helvaci; Sahin, A. O.; Cantón, R.; Ruiz, P.; Bartoletti, M.; Giannella, M.; Taconelli, E.; Riemenschneider, F.; Calbo, E.; Badia, C.; Xercavins, M.; Gasch, E.; Fontanals, D.; Jové, E.

In: Mayo Clinic Proceedings, Vol. 91, No. 10, 01.10.2016, p. 1362-1371.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae

AU - Gutiérrez-Gutiérrez, Belén

AU - Salamanca, Elena

AU - de Cueto, Marina

AU - Pascual, Alvaro

AU - Rodríguez-Baño, Jesús

AU - Hsueh, Po Ren

AU - Viale, Pierluigi

AU - Paño-Pardo, José Ramón

AU - Venditti, Mario

AU - Tumbarello, Mario

AU - Daikos, George

AU - Pintado, Vicente

AU - Doi, Yohei

AU - Tuon, Felipe Francisco

AU - Karaiskos, Ilias

AU - Machuca, Isabel

AU - Schwaber, Mitchell J.

AU - Azap, Özlem Kurt

AU - Souli, Maria

AU - Roilides, Emmanuel

AU - Pournaras, Spyros

AU - Akova, Murat

AU - Pérez, Federico

AU - Bonomo, Robert A.

AU - Bermejo, Joaquín

AU - Oliver, Antonio

AU - Almela, Manel

AU - Lowman, Warren

AU - Almirante, Benito

AU - Carmeli, Yehuda

AU - Paterson, David L.

AU - Falcone, M.

AU - Russo, A.

AU - Giamarellou, H.

AU - Trecarichi, E. M.

AU - Losito, A. R.

AU - García-Vázquez, E.

AU - Hernández, A.

AU - Gómez, J.

AU - Iosifidis, E.

AU - Prim, N.

AU - Navarro, F.

AU - Mirelis, B.

AU - Origüen, J.

AU - San Juan, R.

AU - Fernández-Ruiz, M.

AU - Larrosa, N.

AU - Puig-Asensio, M.

AU - Cisneros, J. M.

AU - Molina, J.

AU - González, V.

AU - Rucci, V.

AU - Ruiz de Gopegui, E.

AU - Marinescu, C. I.

AU - Martínez-Martínez, L.

AU - Fariñas, M. C.

AU - Cano, M. E.

AU - Gozalo, M.

AU - Mora-Rillo, M.

AU - Navarro-San Francisco, C.

AU - Peña, C.

AU - Gómez-Zorrilla, S.

AU - Tubau, F.

AU - Tsakris, A.

AU - Zarkotou, O.

AU - Pitout, J.

AU - Virmani, D.

AU - Torre-Cisneros, J.

AU - Natera, C.

AU - Helvaci,

AU - Sahin, A. O.

AU - Cantón, R.

AU - Ruiz, P.

AU - Bartoletti, M.

AU - Giannella, M.

AU - Taconelli, E.

AU - Riemenschneider, F.

AU - Calbo, E.

AU - Badia, C.

AU - Xercavins, M.

AU - Gasch, E.

AU - Fontanals, D.

AU - Jové, E.

PY - 2016/10/1

Y1 - 2016/10/1

N2 - Objective To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). Patients and Methods A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. Results The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. Conclusion A validated score predictive of early mortality in patients with BSIs due to CPE was developed. Trial Registration clinicaltrials.gov Identifier: NCT01 764490.

AB - Objective To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). Patients and Methods A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. Results The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. Conclusion A validated score predictive of early mortality in patients with BSIs due to CPE was developed. Trial Registration clinicaltrials.gov Identifier: NCT01 764490.

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UR - http://www.scopus.com/inward/citedby.url?scp=84994355438&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2016.06.024

DO - 10.1016/j.mayocp.2016.06.024

M3 - Article

C2 - 27712635

AN - SCOPUS:84994355438

VL - 91

SP - 1362

EP - 1371

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 10

ER -

Gutiérrez-Gutiérrez B, Salamanca E, de Cueto M, Pascual A, Rodríguez-Baño J, Hsueh PR et al. A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae. Mayo Clinic Proceedings. 2016 Oct 1;91(10):1362-1371. https://doi.org/10.1016/j.mayocp.2016.06.024