Raquel Palacios-Baena, Zaira, Gutierrez-Gutierrez, Belen, De Cueto, Marina, Viale, Pierluigi, Venditti, Mario, Hernandez-Torres, Alicia, Oliver, Antonio ORCID: 0000-0001-9327-1894, Martinez-Martinez, Luis, Calbo, Esther, Pintado, Vicente, Gasch, Oriol, Almirante, Benito ORCID: 0000-0002-1189-2361, Antonio Lepe, Jose, Pitout, Johann, Akova, Murat, Pena-Miralles, Carmen, Schwaber, Mitchell J., Tumbarello, Mario ORCID: 0000-0002-9519-8552, Tacconelli, Evelina, Origuen, Julia ORCID: 0000-0002-6507-0363, Prim, Nuria, Bou, German ORCID: 0000-0001-8837-0062, Giamarellou, Helen, Bermejo, Joaquin, Hamprecht, Axel ORCID: 0000-0003-1449-5780, Perez, Federico, Almela, Manuel, Lowman, Warren ORCID: 0000-0002-6981-389X, Hsueh, Po-Ren, Navarro-San Francisco, Carolina, Torre-Cisneros, Julian, Carmeli, Yehuda, Bonomo, Robert A., Paterson, David L., Pascual, Alvaro ORCID: 0000-0002-8672-5891 and Rodriguez-Bano, Jesus ORCID: 0000-0001-6732-9001 (2017). Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extendedspectrum- beta-lactamase-producing Enterobacteriaceae. J. Antimicrob. Chemother., 72 (3). S. 906 - 914. OXFORD: OXFORD UNIV PRESS. ISSN 1460-2091

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Abstract

Background. 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. Methods. 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. Results. 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; 95CI: 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 < 11 and >= 11 were 5.6% and 45.9%, respectively, in the DC, and 5.4% and 34.8% in the VC. Conclusions. We developed and validated an easy-to-collect predictive scoring model for all-cause 30 day mortality useful for identifying patients at high and low risk of mortality.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Raquel Palacios-Baena, ZairaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gutierrez-Gutierrez, BelenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
De Cueto, MarinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Viale, PierluigiUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Venditti, MarioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hernandez-Torres, AliciaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oliver, AntonioUNSPECIFIEDorcid.org/0000-0001-9327-1894UNSPECIFIED
Martinez-Martinez, LuisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Calbo, EstherUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pintado, VicenteUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gasch, OriolUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Almirante, BenitoUNSPECIFIEDorcid.org/0000-0002-1189-2361UNSPECIFIED
Antonio Lepe, JoseUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pitout, JohannUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Akova, MuratUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pena-Miralles, CarmenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schwaber, Mitchell J.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tumbarello, MarioUNSPECIFIEDorcid.org/0000-0002-9519-8552UNSPECIFIED
Tacconelli, EvelinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Origuen, JuliaUNSPECIFIEDorcid.org/0000-0002-6507-0363UNSPECIFIED
Prim, NuriaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bou, GermanUNSPECIFIEDorcid.org/0000-0001-8837-0062UNSPECIFIED
Giamarellou, HelenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bermejo, JoaquinUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hamprecht, AxelUNSPECIFIEDorcid.org/0000-0003-1449-5780UNSPECIFIED
Perez, FedericoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Almela, ManuelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lowman, WarrenUNSPECIFIEDorcid.org/0000-0002-6981-389XUNSPECIFIED
Hsueh, Po-RenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Navarro-San Francisco, CarolinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Torre-Cisneros, JulianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Carmeli, YehudaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bonomo, Robert A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Paterson, David L.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pascual, AlvaroUNSPECIFIEDorcid.org/0000-0002-8672-5891UNSPECIFIED
Rodriguez-Bano, JesusUNSPECIFIEDorcid.org/0000-0001-6732-9001UNSPECIFIED
URN: urn:nbn:de:hbz:38-239061
DOI: 10.1093/jac/dkw513
Journal or Publication Title: J. Antimicrob. Chemother.
Volume: 72
Number: 3
Page Range: S. 906 - 914
Date: 2017
Publisher: OXFORD UNIV PRESS
Place of Publication: OXFORD
ISSN: 1460-2091
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
HOSPITAL ADMISSION; BACTEREMIA; THERAPY; METAANALYSIS; MANAGEMENT; MODELMultiple languages
Infectious Diseases; Microbiology; Pharmacology & PharmacyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/23906

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