Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation
Abstract
:1. Introduction
2. Results
3. Discussion
4. Materials and Methods
4.1. Setting, Patients and Study Design
4.2. Definitions
4.3. Microbiological Studies
4.4. Statistical Analysis
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Center | 1 | 2 | 3 | 4 * | 5 | 6 | 7 | 8 | 9 * | 10 | 11 | 12 | Total |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Patients included | |||||||||||||
n | 71 | 66 | 60 | 7 | 26 | 44 | 58 | 18 | 9 | 31 | 34 | 19 | 443 |
% | 16.0 | 14.9 | 13.5 | 1.6 | 5.9 | 9.9 | 13.1 | 4.1 | 2.0 | 7.0 | 7.7 | 4.3 | 100 |
CRE | |||||||||||||
n | 10 | 2 | 13 | 0 | 1 | 13 | 15 | 0 | 0 | 1 | 2 | 2 | 59 |
% | 14.1 | 3.0 | 21.7 | 0.0 | 3.8 | 29.5 | 25.9 | 0.0 | 0.0 | 3.2 | 5.9 | 10.5 | 13.3 |
blaKPC | |||||||||||||
n | 10 | 2 | 13 | 0 | 1 | 9 | 15 | 0 | 0 | 0 | 2 | 2 | 54 |
% | 14.1 | 3.0 | 21.7 | 0.0 | 3.8 | 20.4 | 25.9 | 0.0 | 0.0 | 0.0 | 5.9 | 10.5 | 12.2 |
blaOXA | |||||||||||||
n | 0 | 0 | 0 | 0 | 0 | 4 | 0 | 0 | 0 | 1 | 0 | 0 | 5 |
% | 0 | 0 | 0 | 0 | 0 | 9.1 | 0 | 0 | 0 | 3.2 | 0 | 0 | 1.1 |
Variables | HM n = 266 n (%) | HSCT n = 85 n (%) | ST n = 92 n (%) | p-Value * |
---|---|---|---|---|
Stage of underlying cancer | ||||
Recently diagnosed | 130 (48.9) | 4 (4.7) | 25 (27.2) | <0.0001 |
Complete remission | 25 (9.4) | 48 (56.5) | 3 (3.3) | <0.0001 |
Partial remission | 23 (8.6) | 13 (15.3) | 26 (28.3) | <0.0001 |
Refractory | 27 (10.2) | 7 (8.2) | 12 (13) | 0.56 |
Relapse | 61 (22.9) | 13 (15.3) | 26 (28.3) | 0.11 |
Recent chemotherapy (1 month prior to bacteremia) | 193 (72.6) | 59 (69.4) | 80 (87) | 0.01 |
Recent radiotherapy (1 month prior to bacteremia) | 9 (3.4) | 8 (9.4) | 14 (15.2) | <0.0001 |
Receiving steroids during bacteremia | 96 (36.1) | 32 (37.6) | 22 (23.9) | 0.07 |
Receiving biological agents | 27 (10.2) | 19 (22.4) | 6 (6.5) | 0.002 |
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Variables | CSE n = 384 n (%) | CRE n = 59 n (%) | p-Value * |
---|---|---|---|
Age (years) (median, IQR) | 55.5 (37–66) | 51 (39–64) | 0.31 |
Male gender | 216 (56.3) | 35 (59.3) | 0.65 |
Inclusion criteria | |||
Hematologic malignancy | 226 (58.8) | 40 (67.8) | 0.19 |
Solid malignancy | 89 (23.2) | 3 (5.1) | 0.001 |
Hematopoietic Stem Cell Transplant | 69 (18) | 16 (27.1) | 0.09 |
Stage of underlying cancer | |||
Recently diagnosed | 126 (32.8) | 33(55.9) | 0.001 |
Complete remission | 65 (17) | 11(18.6) | 0.74 |
Partial remission | 57 (14.8) | 5 (8.5) | 0.23 |
Refractory | 43 (11.2) | 3 (5.1) | 0.17 |
Relapse | 93 (24.2) | 7 (11.9) | 0.03 |
Recent chemotherapy (1 month prior to bacteremia) | 290 (75.5) | 42 (71.2) | 0.47 |
Recent radiotherapy (1 month prior to bacteremia) | 28 (7.3) | 3 (5.1) | 0.78 |
Receiving steroids during bacteremia | 125 (32.5) | 35 (59.3) | 0.13 |
Charlson comorbidity index (median, IQR) | 2 (2–3) | 2 (2–3) | 0.21 |
Neutropenia | 258 (67.2) | 52 (88.1) | 0.001 |
High risk by MASCC score | 222 (86) | 49 (94.2) | 0.10 |
Neutropenia duration (days) (IQR) | 11 (6–19) | 16 (10–24) | 0.004 |
Recent hospitalization (1 month prior to bacteremia) | 204 (53.1) | 32 (54.2) | 0.87 |
Recent antibiotic use (1 month prior to bacteremia) | 158 (41.1) | 45 (76.3) | <0.001 |
Fluoroquinolone prophylaxis | 64 (16.7) | 13 (22) | 0.31 |
Variables | CSE n (%) | CRE n (%) | p-Value * |
---|---|---|---|
Nosocomial infection | 241 (62.8) | 55 (93.2) | <0.001 |
Bacteremia with clinical source | 286 (74.5) | 34 (57.6) | 0.007 |
Abdominal | 115 (29.9) | 14 (23.7) | 0.32 |
Central venous catheter | 40 (10.4) | 10 (16.9) | 0.14 |
Urinary tract | 55 (14.3) | 2 (3.4) | 0.02 |
Adequate EAT | 352 (91.7) | 28 (47.5) | <0.001 |
Empirical antibiotic monotherapy | 283 (73.6) | 38 (64.4) | 0.13 |
Combined definitive antibiotic treatment | 22 (5.7) | 57 (96.6) | <0.001 |
APACHE II score the day of bacteremia (median, IQR) | 13 (9–17) | 12 (8–17) | 0.16 |
PITT score the day of bacteremia (median, IQR) | 0 (0–2) | 0 (0–2) | 0.39 |
Intensive care unit admission required | 86 (22.4) | 29 (49.1) | <0.001 |
Shock development | 83 (21.6) | 30 (50.8) | <0.001 |
Breakthrough bacteremia | 20 (5.2) | 14 (23.7) | <0.001 |
7-day mortality | 45 (11.7) | 21 (35.6) | <0.001 |
Infection-related | 37 (82.2) | 21 (100) | 0.03 |
30-day mortality | 68 (17.7) | 32 (54.2) | <0.001 |
Infection-related | 47 (69.1) | 27 (84.4) | 0.08 |
More than 24-h delay in adequate antibiotic treatment | 27 (7) | 26 (44.1) | <0.001 |
Variables | Univariate Analysis | Multivariate Analysis | Points | ||
---|---|---|---|---|---|
OR (95%CI) | p-Value | OR (95%CI) | p-Value | ||
Recent carbapenems use | 4.1 (2.3–7.7) | 0.001 | |||
>7 days of antibiotic use prior to bacteremia | 4.6 (2.6–4.1) | 0.001 | 4.65 (2.29–9.46) | <0.001 | 2 |
Neutropenia | 3.6 (1.6–8.2) | 0.002 | |||
≥10-days of hospitalization prior to bacteremia | 4.4 (2.3–8.6) | 0.001 | 4.03 (1.88–8.66) | <0.001 | 2 |
Recent intensive care unit admission | 3 (1.4–6.8) | 0.006 | |||
Central venous catheter in place | 3.4 (1.7–6.7) | 0.002 | |||
Previous colonization with KPC-CPE | 10.6 (4.4–25.5) | 0.001 | |||
Recent colonization with KPC-CPE | 24.9 (1.3–55) | 0.001 | 33.08 (11.7–93.25) | <001 | 5 |
Point of the Score | Sensitivity | Specificity | +LR | −LR | Positive Post-Test Probability | Negative Post-Test Probability |
---|---|---|---|---|---|---|
≥0 | 100.00% | 0.00% | 1 | 13.30% | ||
≥2 | 94.92% | 40.21% | 1.5874 | 0.1265 | 19.58% | 1.90% |
≥4 | 76.27% | 83.81% | 4.7116 | 0.2831 | 41.95% | 4.16% |
≥5 | 42.37% | 97.13% | 14.7535 | 0.5933 | 69.36% | 8.34% |
≥7 | 35.59% | 98.43% | 22.7204 | 0.6543 | 77.71% | 9.12% |
≥9 | 20.34% | 99.22% | 25.9662 | 0.8029 | 79.93% | 10.97% |
>9 | 0.00% | 100.00% | 1 | 0.00% | 13.30% |
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Herrera, F.; Torres, D.; Laborde, A.; Berruezo, L.; Jordán, R.; Rossi, I.R.; Valledor, A.; Costantini, P.; Dictar, M.; Nenna, A.; et al. Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation. Antibiotics 2023, 12, 226. https://doi.org/10.3390/antibiotics12020226
Herrera F, Torres D, Laborde A, Berruezo L, Jordán R, Rossi IR, Valledor A, Costantini P, Dictar M, Nenna A, et al. Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation. Antibiotics. 2023; 12(2):226. https://doi.org/10.3390/antibiotics12020226
Chicago/Turabian StyleHerrera, Fabián, Diego Torres, Ana Laborde, Lorena Berruezo, Rosana Jordán, Inés Roccia Rossi, Alejandra Valledor, Patricia Costantini, Miguel Dictar, Andrea Nenna, and et al. 2023. "Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation" Antibiotics 12, no. 2: 226. https://doi.org/10.3390/antibiotics12020226