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Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation

Authors :
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
Source :
Antibiotics, Vol 12, Iss 2, p 226 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

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.

Details

Language :
English
ISSN :
20796382
Volume :
12
Issue :
2
Database :
Directory of Open Access Journals
Journal :
Antibiotics
Publication Type :
Academic Journal
Accession number :
edsdoj.0e3d96e7081a4037b0fabebf67920c10
Document Type :
article
Full Text :
https://doi.org/10.3390/antibiotics12020226