Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation
Identifying the risk factors for carbapenem-resistant Enterobacterales (CRE) bacteremia in cancer and hematopoietic stem cell transplantation (HSCT) patients would allow earlier initiation of an appropriate empirical antibiotic treatment. This is a prospective multicenter observational study in pati...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-01-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/12/2/226 |
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| author | Fabián Herrera Diego Torres Ana Laborde Lorena Berruezo Rosana Jordán Inés Roccia Rossi Alejandra Valledor Patricia Costantini Miguel Dictar Andrea Nenna María Laura Pereyra Sandra Lambert José Benso Fernando Poletta María Luz Gonzalez Ibañez Nadia Baldoni María José Eusebio Fiorella Lovano Laura Barcán Martín Luck Agustina Racioppi Lucas Tula Fernando Pasterán Alejandra Corso Melina Rapoport Federico Nicola María Cristina García Damiano Ruth Carbone Renata Monge Mariana Reynaldi Graciela Greco Marcelo Bronzi Sandra Valle María Laura Chaves Viviana Vilches Miriam Blanco Alberto Ángel Carena |
| author_facet | Fabián Herrera Diego Torres Ana Laborde Lorena Berruezo Rosana Jordán Inés Roccia Rossi Alejandra Valledor Patricia Costantini Miguel Dictar Andrea Nenna María Laura Pereyra Sandra Lambert José Benso Fernando Poletta María Luz Gonzalez Ibañez Nadia Baldoni María José Eusebio Fiorella Lovano Laura Barcán Martín Luck Agustina Racioppi Lucas Tula Fernando Pasterán Alejandra Corso Melina Rapoport Federico Nicola María Cristina García Damiano Ruth Carbone Renata Monge Mariana Reynaldi Graciela Greco Marcelo Bronzi Sandra Valle María Laura Chaves Viviana Vilches Miriam Blanco Alberto Ángel Carena |
| author_sort | Fabián Herrera |
| collection | DOAJ |
| description | Identifying the risk factors for carbapenem-resistant Enterobacterales (CRE) bacteremia in cancer and hematopoietic stem cell transplantation (HSCT) patients would allow earlier initiation of an appropriate empirical antibiotic treatment. This is a prospective multicenter observational study in patients from 12 centers in Argentina, who presented with cancer or hematopoietic stem-cell transplant and developed Enterobacterales bacteremia. A multiple logistic regression model identified risk factors for CRE bacteremia, and a score was developed according to the regression coefficient. This was validated by the bootstrap resampling technique. Four hundred and forty-three patients with Enterobacterales bacteremia were included: 59 with CRE and 384 with carbapenem-susceptible Enterobacterales (CSE). The risk factors that were identified and the points assigned to each of them were: ≥10 days of hospitalization until bacteremia: OR 4.03, 95% CI 1.88–8.66 (2 points); previous antibiotics > 7 days: OR 4.65, 95% CI 2.29–9.46 (2 points); current colonization with KPC-carbapenemase-producing Enterobacterales: 33.08, 95% CI 11.74–93.25 (5 points). With a cut-off of 7 points, a sensitivity of 35.59%, specificity of 98.43%, PPV of 77.7%, and NPV of 90.9% were obtained. The overall performance of the score was satisfactory (AUROC of 0.85, 95% CI 0.80–0.91). Finally, the post-test probability of CRE occurrence in patients with none of the risk factors was 1.9%, which would virtually rule out the presence of CRE bacteremia. |
| first_indexed | 2024-03-11T09:14:40Z |
| format | Article |
| id | doaj.art-0e3d96e7081a4037b0fabebf67920c10 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-11T09:14:40Z |
| publishDate | 2023-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-0e3d96e7081a4037b0fabebf67920c102023-11-16T18:41:57ZengMDPI AGAntibiotics2079-63822023-01-0112222610.3390/antibiotics12020226Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell TransplantationFabián Herrera0Diego Torres1Ana Laborde2Lorena Berruezo3Rosana Jordán4Inés Roccia Rossi5Alejandra Valledor6Patricia Costantini7Miguel Dictar8Andrea Nenna9María Laura Pereyra10Sandra Lambert11José Benso12Fernando Poletta13María Luz Gonzalez Ibañez14Nadia Baldoni15María José Eusebio16Fiorella Lovano17Laura Barcán18Martín Luck19Agustina Racioppi20Lucas Tula21Fernando Pasterán22Alejandra Corso23Melina Rapoport24Federico Nicola25María Cristina García Damiano26Ruth Carbone27Renata Monge28Mariana Reynaldi29Graciela Greco30Marcelo Bronzi31Sandra Valle32María Laura Chaves33Viviana Vilches34Miriam Blanco35Alberto Ángel Carena36Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, ArgentinaCentro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, ArgentinaFUNDALEU, Buenos Aires C1114, ArgentinaHospital HIGA Rodolfo Rossi, La Plata B1902, ArgentinaHospital Británico de Buenos Aires, Buenos Aires C1280, ArgentinaHospital HIGA Gral San Martín, La Plata B1900, ArgentinaHospital Italiano de Buenos Aires, Buenos Aires C1199, ArgentinaInstituto de Oncología Angel H. Roffo, Buenos Aires C1417, ArgentinaInstituto Alexander Fleming, Buenos Aires C1426, ArgentinaHospital Municipal de Oncología Marie Curie, Buenos Aires C1405, ArgentinaHospital Universitario Austral, Buenos Aires B1629, ArgentinaHospital El Cruce, Buenos Aires B1888, ArgentinaHospital Italiano de San Justo, Buenos Aires C1198, ArgentinaCentro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, ArgentinaFUNDALEU, Buenos Aires C1114, ArgentinaHospital HIGA Rodolfo Rossi, La Plata B1902, ArgentinaHospital Británico de Buenos Aires, Buenos Aires C1280, ArgentinaHospital HIGA Gral San Martín, La Plata B1900, ArgentinaHospital Italiano de Buenos Aires, Buenos Aires C1199, ArgentinaInstituto de Oncología Angel H. Roffo, Buenos Aires C1417, ArgentinaInstituto Alexander Fleming, Buenos Aires C1426, ArgentinaHospital El Cruce, Buenos Aires B1888, ArgentinaServicio de Antimicrobianos, ANLIS Malbrán, Buenos Aires C1282, ArgentinaServicio de Antimicrobianos, ANLIS Malbrán, Buenos Aires C1282, ArgentinaServicio de Antimicrobianos, ANLIS Malbrán, Buenos Aires C1282, ArgentinaCentro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, ArgentinaFUNDALEU, Buenos Aires C1114, ArgentinaHospital HIGA Rodolfo Rossi, La Plata B1902, ArgentinaHospital Británico de Buenos Aires, Buenos Aires C1280, ArgentinaHospital HIGA Gral San Martín, La Plata B1900, ArgentinaHospital Italiano de Buenos Aires, Buenos Aires C1199, ArgentinaInstituto de Oncología Angel H. Roffo, Buenos Aires C1417, ArgentinaInstituto Alexander Fleming, Buenos Aires C1426, ArgentinaHospital Municipal de Oncología Marie Curie, Buenos Aires C1405, ArgentinaHospital Universitario Austral, Buenos Aires B1629, ArgentinaHospital El Cruce, Buenos Aires B1888, ArgentinaCentro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, ArgentinaIdentifying the risk factors for carbapenem-resistant Enterobacterales (CRE) bacteremia in cancer and hematopoietic stem cell transplantation (HSCT) patients would allow earlier initiation of an appropriate empirical antibiotic treatment. This is a prospective multicenter observational study in patients from 12 centers in Argentina, who presented with cancer or hematopoietic stem-cell transplant and developed Enterobacterales bacteremia. A multiple logistic regression model identified risk factors for CRE bacteremia, and a score was developed according to the regression coefficient. This was validated by the bootstrap resampling technique. Four hundred and forty-three patients with Enterobacterales bacteremia were included: 59 with CRE and 384 with carbapenem-susceptible Enterobacterales (CSE). The risk factors that were identified and the points assigned to each of them were: ≥10 days of hospitalization until bacteremia: OR 4.03, 95% CI 1.88–8.66 (2 points); previous antibiotics > 7 days: OR 4.65, 95% CI 2.29–9.46 (2 points); current colonization with KPC-carbapenemase-producing Enterobacterales: 33.08, 95% CI 11.74–93.25 (5 points). With a cut-off of 7 points, a sensitivity of 35.59%, specificity of 98.43%, PPV of 77.7%, and NPV of 90.9% were obtained. The overall performance of the score was satisfactory (AUROC of 0.85, 95% CI 0.80–0.91). Finally, the post-test probability of CRE occurrence in patients with none of the risk factors was 1.9%, which would virtually rule out the presence of CRE bacteremia.https://www.mdpi.com/2079-6382/12/2/226scoreEnterobacteralesbacteremiacancer |
| spellingShingle | Fabián Herrera Diego Torres Ana Laborde Lorena Berruezo Rosana Jordán Inés Roccia Rossi Alejandra Valledor Patricia Costantini Miguel Dictar Andrea Nenna María Laura Pereyra Sandra Lambert José Benso Fernando Poletta María Luz Gonzalez Ibañez Nadia Baldoni María José Eusebio Fiorella Lovano Laura Barcán Martín Luck Agustina Racioppi Lucas Tula Fernando Pasterán Alejandra Corso Melina Rapoport Federico Nicola María Cristina García Damiano Ruth Carbone Renata Monge Mariana Reynaldi Graciela Greco Marcelo Bronzi Sandra Valle María Laura Chaves Viviana Vilches Miriam Blanco Alberto Ángel Carena Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation Antibiotics score Enterobacterales bacteremia cancer |
| title | Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_full | Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_fullStr | Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_full_unstemmed | Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_short | Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_sort | development of a clinical score to stratify the risk for carbapenem resistant enterobacterales bacteremia in patients with cancer and hematopoietic stem cell transplantation |
| topic | score Enterobacterales bacteremia cancer |
| url | https://www.mdpi.com/2079-6382/12/2/226 |
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