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3 results on '"INCREMENT risk score"'

1. External validation of the INCREMENT-CPE mortality score in a carbapenem-resistant Klebsiella pneumoniae bacteraemia cohort: the prognostic significance of colistin resistance.

Author

Machuca, Isabel, Gutiérrez-Gutiérrez, Belén, Rivera-Espinar, Francisco, Cano, Angela, Gracia-Ahufinger, Irene, Guzman-Puche, Julia, Marfil-Pérez, Eduardo, Pérez-Nadales, Elena, Castón, Juan José, Bonomo, Robert A., Carmeli, Yehuda, Paterson, David, Pascual, Álvaro, Martínez-Martínez, Luís, Rodríguez-Baño, Jesús, and Torre-Cisneros, Julián

Subjects
*KLEBSIELLA pneumoniae, *RECEIVER operating characteristic curves, *MORTALITY, *COLISTIN
Abstract

• Carbapenem-resistant Klebsiella pneumoniae (CRKp) infections are associated with high mortality. • The INCREMENT-CPE score (ICS) allows a categorisation of mortality risk. • External validation of the ICS for all-cause 30-day mortality is needed. • Colistin resistance was not clearly associated with increased mortality. 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. [ABSTRACT FROM AUTHOR]

Published
2019
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2. External validation of the INCREMENT-CPE mortality score in a carbapenem-resistant Klebsiella pneumoniae bacteraemia cohort: the prognostic significance of colistin resistance

Author

Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, European Commission, Machuca, Isabel, Gutiérrez-Gutiérrez, Belén, Rivera-Espinar, Francisco, Cano, Ángela, Gracia-Ahufinger, Irene, Guzmán-Puche, Julia, Marfil-Pérez, Eduardo, Pérez-Nadales, Elena, Castón, Juan José, Bonomo, Robert A., Carmeli, Yehuda, Paterson, David L., Pascual, Álvaro, Martínez-Martínez, Luis, Rodríguez-Baño, Jesús, Torre-Cisneros, Julián, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, European Commission, Machuca, Isabel, Gutiérrez-Gutiérrez, Belén, Rivera-Espinar, Francisco, Cano, Ángela, Gracia-Ahufinger, Irene, Guzmán-Puche, Julia, Marfil-Pérez, Eduardo, Pérez-Nadales, Elena, Castón, Juan José, Bonomo, Robert A., Carmeli, Yehuda, Paterson, David L., Pascual, Álvaro, Martínez-Martínez, Luis, Rodríguez-Baño, Jesús, and Torre-Cisneros, Julián

Abstract

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.

Published
2019

3. External validation of the INCREMENT-CPE mortality score in a carbapenem-resistant Klebsiella pneumoniae bacteraemia cohort: the prognostic significance of colistin resistance

Author

Belén Gutiérrez-Gutiérrez, Álvaro Pascual, Eduardo Marfil-Pérez, Irene Gracia-Ahufinger, Yehuda Carmeli, Julián Torre-Cisneros, Isabel Machuca, Francisco Rivera-Espinar, Elena Pérez-Nadales, Julia Guzmán-Puche, Robert A. Bonomo, Angela Cano, Jesús Rodríguez-Baño, David L. Paterson, Juan José Castón, Luis Martínez-Martínez, Instituto de Salud Carlos III, Ministerio de Economía, Industria y Competitividad (España), Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, and European Commission

Subjects
0301 basic medicine, Microbiology (medical), Male, medicine.medical_specialty, Combination therapy, Carbapenem resistance, 030106 microbiology, Colistin resistance, Bacteremia, Drug resistance, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, Clinical Decision Rules, Drug Resistance, Bacterial, INCREMENT risk score, Medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, Aged, Antiinfective agent, Framingham Risk Score, Receiver operating characteristic, business.industry, Colistin, General Medicine, Odds ratio, Middle Aged, Prognosis, bacterial infections and mycoses, Survival Analysis, Anti-Bacterial Agents, Klebsiella Infections, KPC, Klebsiella pneumoniae, Infectious Diseases, Carbapenem-Resistant Enterobacteriaceae, ROC Curve, Cohort, Female, business, medicine.drug
Abstract

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., This study was supported by Plan Nacional de I+D+i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y Competitividad, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0001; RD16/0016/0008], co-financed by the European Regional Development Fund ‘A way to achieve Europe’, Operative Program Intelligent Growth 2014–2020.

Published
2019

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