External validation of the INCREMENT-CPE mortality score in a carbapenem-resistant Klebsiella pneumoniae bacteraemia cohort: the prognostic significance of colistin resistance
Por:
Machuca, I, Gutierrez-Gutierrez, B, Rivera-Espinar, F, Cano, A, Gracia-Ahufinger, I, Guzman-Puche, J, Marfil-Perez, E, Perez-Nadales, E, Caston, JJ, Bonomo, RA, Carmeli, Y, Paterson, D, Pascual, A, Martinez-Martinez, L, Rodriguez-Bano, J, Torre-Cisneros, J, Salamanca, E, de Cueto, M, Hsueh, PR, Viale, P, Bartoletti, M, Giannella, M, Pano-Pardo, JR, Mora-Rillo, M, Navarro-San Francisco, C, Venditti, M, Falcone, M, Russo, A, Tumbarello, M, Trecarichi, EM, Losito, AR, Daikos, G, Skiada, A, Canton, R, Pintado, V, Ruiz, P, Doi, Y, Tuon, FF, Karaiskos, I, Giamarellou, H, Schwaber, MJ, Azap, OK, Souli, M, Antoniadou, A, Poulakou, G, Roilides, E, Iosifidis, E, Pournaras, S, Tsakris, A, Zarkotou, O, Akova, M, Helvaci, O, Sahin, AO, Perez, F, Bermejo, J, Rucci, V, Oliver, A, de Gopegui, ER, Marinescu, CI, de la Calle, C, Martinez, JA, Morata, L, Soriano, A, Lowman, W, Almirante, B, Larrosa, N, Puig-Asensio, M, Garcia-Vazquez, E, Hernandez, A, Gomez, J, Bou, G, Prim, N, Navarro, F, Mirelis, B, Origuen, J, San Juan, R, Fernandez-Ruiz, M, Cisneros, JM, Molina, J, Gonzalez, V, Farinas, MC, Cano, ME, Gozalo, M, Pena, C, Gomez-Zorrilla, S, Tubau, F, Pitout, J, Virmani, D, Natera, C, Marfil, E, Tacconelli, E, Riemenschneider, F, Calbo, E, Badia, C, Xercavins, M, Gasch, O, Fontanals, D, Jove, E
Publicada:
1 oct 2019
Resumen:
External validation of the INCREMENT-CPE risk score (ICS) for 30-day all-cause mortality is needed. There is also scarce information about whether colistin resistance influences the prognosis of carbapenem-resistant Klebsiella pneumoniae (CRKp) bacteraemia. In this study, the ability of ICS to predict all-cause mortality in the KAPECOR cohort was calculated using the area under the receiver operating characteristic (AUROC) curve. The association of colistin resistance with mortality was studied. The ICS showed an AUROC curve of 0.77 (95% CI 0.68-0.86). A cut-off of 8 points showed 96.8% sensitivity and 50.7% specificity. Mortality of low-risk patients was not different in those treated with monotherapy versus combination therapy. However, mortality of high-risk patients treated with combination therapy (37.8%) was significantly lower than in those treated with monotherapy (68.4%) (P = 0.008). To study the prognostic significance of colistin resistance, 83 selected cases of bacteraemia due to colistin-susceptible CRKp were obtained from the INCREMENT cohort for comparison. Colistin resistance could not be shown to be associated with higher mortality in either the high-risk ICS group [adjusted odds ratio (aOR) = 1.56, 95% CI 0.69-3.33; P = 0.29] or in 37 ICS-matched pairs (aOR = 1.38, 95% CI 0.55-3.42; P = 0.49), or in a sensitivity analysis including only KPC isolates (aOR = 1.81, 95% CI 0.73-4.57; P = 0.20), but the precision of estimates was low. These results validate ICS for all-cause mortality and to optimise targeted therapy for CRKp bacteraemia. Colistin resistance was not clearly associated with increased mortality. (C) 2019 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
Filiaciones:
Machuca, I:
Univ Cordoba, Hosp Univ Reina Sofia, Infect Dis Unit, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain
Gutierrez-Gutierrez, B:
Univ Seville, Hosp Univ Virgen Macarena & Virgen Rocio IBiS, Infect Dis Clin Microbiol & Prevent Med Unit, Seville, Spain
Univ Seville, Dept Med, Seville, Spain
Rivera-Espinar, F:
Hosp Univ Reina Sofia, Intens Care Unit, Cordoba, Spain
Cano, A:
Univ Cordoba, Hosp Univ Reina Sofia, Infect Dis Unit, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain
Gracia-Ahufinger, I:
Univ Cordoba, Inst Maimonides Invest Biomed Cordoba IMIBIC, Hosp Univ Reina Sofia, Unit Microbiol, Cordoba, Spain
Guzman-Puche, J:
Univ Cordoba, Inst Maimonides Invest Biomed Cordoba IMIBIC, Hosp Univ Reina Sofia, Unit Microbiol, Cordoba, Spain
Marfil-Perez, E:
Univ Cordoba, Inst Maimonides Invest Biomed Cordoba IMIBIC, Hosp Univ Reina Sofia, Unit Microbiol, Cordoba, Spain
Perez-Nadales, E:
Univ Cordoba, Hosp Univ Reina Sofia, Infect Dis Unit, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain
Caston, JJ:
Univ Cordoba, Hosp Univ Reina Sofia, Infect Dis Unit, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain
Bonomo, RA:
Louis Stokes Cleveland Dept Vet Affairs, Med Ctr, Res Serv, Cleveland, OH USA
Case Western Reserve Univ, Sch Med, Dept Med, Cleveland, OH 44106 USA
Case Western Reserve Univ, Sch Med, Dept Pharmacol, Cleveland, OH 44106 USA
Case Western Reserve Univ, Sch Med, Dept Biochem, Cleveland, OH 44106 USA
Case Western Reserve Univ, Sch Med, Dept Mol Biol & Microbiol, Cleveland, OH 44106 USA
Carmeli, Y:
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Israel Minist Hlth, Natl Ctr Infect Control, Tel Aviv, Israel
Paterson, D:
Univ Queensland, Ctr Clin Res, Brisbane, Qld, Australia
Pascual, A:
Univ Seville, Hosp Univ Virgen Macarena & Virgen Rocio IBiS, Infect Dis Clin Microbiol & Prevent Med Unit, Seville, Spain
Univ Seville, Dept Med, Seville, Spain
Martinez-Martinez, L:
Univ Cordoba, Inst Maimonides Invest Biomed Cordoba IMIBIC, Hosp Univ Reina Sofia, Unit Microbiol, Cordoba, Spain
Rodriguez-Bano, J:
Univ Seville, Hosp Univ Virgen Macarena & Virgen Rocio IBiS, Infect Dis Clin Microbiol & Prevent Med Unit, Seville, Spain
Univ Seville, Dept Med, Seville, Spain
Torre-Cisneros, J:
Univ Cordoba, Hosp Univ Reina Sofia, Infect Dis Unit, Inst Maimonides Invest Biomed Cordoba IMIBIC, Cordoba, Spain
Hosp Univ Reina Sofia, Unidad Clin Enfermedades Infecciosos, Avda Menendez Pidal S-N, Cordoba 14004, Spain
Salamanca, E:
Hosp Univ Virgen Macarena IBis, Seville, Spain
de Cueto, M:
Hosp Univ Virgen Macarena IBis, Seville, Spain
Hsueh, PR:
Natl Taiwan Univ Hosp, Taipei, Taiwan
Viale, P:
Teaching Hosp Policlin S Orsola Malpighi, Bologna, Italy
Bartoletti, M:
Teaching Hosp Policlin S Orsola Malpighi, Bologna, Italy
Giannella, M:
Teaching Hosp Policlin S Orsola Malpighi, Bologna, Italy
Pano-Pardo, JR:
Hosp La Paz, IDIPAZ, Madrid, Spain
Mora-Rillo, M:
Hosp La Paz, IDIPAZ, Madrid, Spain
Navarro-San Francisco, C:
Hosp La Paz, IDIPAZ, Madrid, Spain
Venditti, M:
Policlin Umberto 1, Rome, Italy
Falcone, M:
Policlin Umberto 1, Rome, Italy
Russo, A:
Policlin Umberto 1, Rome, Italy
Tumbarello, M:
Univ Cattolica Sacro Cuore, Rome, Italy
Trecarichi, EM:
Univ Cattolica Sacro Cuore, Rome, Italy
Losito, AR:
Univ Cattolica Sacro Cuore, Rome, Italy
Daikos, G:
Natl & Kapodistrian Univ Athens, Laikon Gen Hosp, Athens, Greece
Skiada, A:
Natl & Kapodistrian Univ Athens, Laikon Gen Hosp, Athens, Greece
Canton, R:
Hosp Ramon & Cajal, Madrid, Spain
Pintado, V:
Hosp Ramon & Cajal, Madrid, Spain
Ruiz, P:
Hosp Ramon & Cajal, Madrid, Spain
Doi, Y:
Univ Pittsburgh, Pittsburgh, PA USA
Tuon, FF:
Hosp Univ Fed Parana, Curitiba, Parana, Brazil
Karaiskos, I:
Hygeia Gen Hosp, Athens, Greece
Giamarellou, H:
Hygeia Gen Hosp, Athens, Greece
Schwaber, MJ:
Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel
Israel Minist Hlth, Natl Ctr Infect Control, Tel Aviv, Israel
Azap, OK:
Baskent Univ, Fac Med, Ankara, Turkey
Souli, M:
Univ Gen Hosp Attikon, Chaidiri, Greece
Antoniadou, A:
Univ Gen Hosp Attikon, Chaidiri, Greece
Poulakou, G:
Univ Gen Hosp Attikon, Chaidiri, Greece
Roilides, E:
Hippokrateion Hosp, Thessaloniki, Greece
Iosifidis, E:
Hippokrateion Hosp, Thessaloniki, Greece
Pournaras, S:
Natl & Kapodistrian Univ Athens, Med Sch, Athens, Greece
Tsakris, A:
Natl & Kapodistrian Univ Athens, Med Sch, Athens, Greece
Zarkotou, O:
Natl & Kapodistrian Univ Athens, Med Sch, Athens, Greece
Akova, M:
Hacettepe Univ, Ankara, Turkey
Helvaci, O:
Hacettepe Univ, Ankara, Turkey
Sahin, AO:
Hacettepe Univ, Ankara, Turkey
Perez, F:
Louis Stokes Cleveland Dept Vet Affairs Med Ctr, Res Serv, Cleveland, OH USA
Bermejo, J:
Hosp Espanol, Rosario, Argentina
Rucci, V:
Hosp Espanol, Rosario, Argentina
Oliver, A:
Hosp Univ Son Espases, Palma De Mallorca, Spain
de Gopegui, ER:
Hosp Univ Son Espases, Palma De Mallorca, Spain
Marinescu, CI:
Hosp Univ Son Espases, Palma De Mallorca, Spain
de la Calle, C:
Hosp Clin Barcelona, Barcelona, Spain
Martinez, JA:
Hosp Clin Barcelona, Barcelona, Spain
Morata, L:
Hosp Clin Barcelona, Barcelona, Spain
Soriano, A:
Hosp Clin Barcelona, Barcelona, Spain
Lowman, W:
Wits Donald Gordon Med Ctr, Johannesburg, South Africa
Almirante, B:
Hosp Univ Vall dHebron, Barcelona, Spain
Larrosa, N:
Hosp Univ Vall dHebron, Barcelona, Spain
Puig-Asensio, M:
Hosp Univ Vall dHebron, Barcelona, Spain
Garcia-Vazquez, E:
Hosp Univ Virgen Arrixaca, Murcia, Spain
Hernandez, A:
Hosp Univ Virgen Arrixaca, Murcia, Spain
Gomez, J:
Hosp Univ Virgen Arrixaca, Murcia, Spain
Bou, G:
Complejo Hosp Univ A Coruna, La Coruna, Spain
Prim, N:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Navarro, F:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Mirelis, B:
Hosp Santa Creu & Sant Pau, Barcelona, Spain
Origuen, J:
Hosp 12 Octubre, Madrid, Spain
San Juan, R:
Hosp 12 Octubre, Madrid, Spain
Fernandez-Ruiz, M:
Hosp 12 Octubre, Madrid, Spain
Cisneros, JM:
Hosp Univ Virgen Rocio IBis, Seville, Spain
Molina, J:
Hosp Univ Virgen Rocio IBis, Seville, Spain
Gonzalez, V:
Hosp Univ Virgen Rocio IBis, Seville, Spain
Farinas, MC:
Hosp Univ Marques Valdecilla IDIVAL, Santander, Spain
Cano, ME:
Hosp Univ Marques Valdecilla IDIVAL, Santander, Spain
Gozalo, M:
Hosp Univ Marques Valdecilla IDIVAL, Santander, Spain
Pena, C:
Hosp Bellvitge Princeps Espanya, Barcelona, Spain
Gomez-Zorrilla, S:
Hosp Bellvitge Princeps Espanya, Barcelona, Spain
Tubau, F:
Hosp Bellvitge Princeps Espanya, Barcelona, Spain
Pitout, J:
Univ Calgary, Calgary, AB, Canada
Virmani, D:
Univ Calgary, Calgary, AB, Canada
Natera, C:
Univ Cordoba, Reina Sofia Univ Hosp IMIBIC, Cordoba, Spain
Marfil, E:
Univ Cordoba, Reina Sofia Univ Hosp IMIBIC, Cordoba, Spain
Tacconelli, E:
Univ Klinikum Tubingen, Tubingen, Germany
Riemenschneider, F:
Univ Klinikum Tubingen, Tubingen, Germany
Calbo, E:
Hosp Univ Mutua Terrassa, Terrassa, Spain
Badia, C:
Hosp Univ Mutua Terrassa, Terrassa, Spain
Xercavins, M:
Hosp Univ Mutua Terrassa, Terrassa, Spain
Gasch, O:
Hosp Parc Tauli, Sabadell, Spain
Fontanals, D:
Hosp Parc Tauli, Sabadell, Spain
Jove, E:
Hosp Parc Tauli, Sabadell, Spain
|