Background: Management of infections due to carbapenemase-resistant Enterobacterales (CRE) in solid organ transplant (SOT) recipients remains a difficult challenge. The INCREMENT-SOT-CPE score has been specifically developed from SOT recipients to stratify mortality risk, but an external validation is lacking.Methods: Multicenter retrospective cohort study of liver transplant (LT) recipients colonized with CRE infection who developed infection after transplant over 7-year period. Primary endpoint was all-cause 30-day mortality from infection onset. A comparison between INCREMENT-SOT-CPE and other selected scores was performed. A two-level mixed effects logistic regression model with random effects for the center was fitted. Performance characteristics at optimal cut-point were calculated. Multivariable Cox regression analysis of risk factors for all-cause 30-day mortality was carried out.Results: Overall, 250 CRE carriers developed infection after LT and were analyzed. The median age was 55 years (interquartile range [IQR]: 46-62) and 157 were males (62.8%). All-cause 30-day mortality was 35.6%. A sequential organ failure assessment (SOFA) score >= 11 showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 69.7%, 76.4%, 62.0%, 82.0%, and 74.0%, respectively. An INCREMENT-SOT-CPE >= 11 reported a sensitivity, specificity, PPV, NPV, and accuracy of 73.0%, 62.1%, 51.6%, 80.6% and 66.0%, respectively. At multivariable analysis acute renal failure, prolonged mechanical ventilation, INCREMENT-SOT-CPE score >= 11 and SOFA score >= 11 were independently associated with all-cause 30-day mortality, while a tigecycline-based targeted regimen was found to be protective.Conclusions: Both INCREMENT-SOT-CPE >= 11 and SOFA >= 11 were identified as strong predictors of all-cause 30-day mortality in a large cohort of CRE carriers developing infection after LT.

Validation of the INCREMENT-SOT-CPE score in a large cohort of liver transplant recipients with carbapenem-resistant Enterobacterales infection / Rinaldi M.; Bonazzetti C.; Gallo M.; Ferraro G.; Freire M.; Terrabuio D.R.B.; Tandoi F.; Romagnoli R.; De Rosa F.G.; Mularoni A.; Ferrarese A.; Burra P.; Halpern M.; Balbi E.; Simkins J.; Abbo L.; Morrás I.; Cantero M.; Alagna L.; Bandera A.; Clemente W.T.; Valerio M.; Fernández A.; Muñoz P.; Statlender L.; Yahav D.; Camargo L.F.A.; Girão E.S.; Grossi P.; Viale P.; Curti S.; Giannella M.. - In: TRANSPLANT INFECTIOUS DISEASE. - ISSN 1398-2273. - ELETTRONICO. - 25:2(2023), pp. e14036.1-e14036.9. [10.1111/tid.14036]

Validation of the INCREMENT-SOT-CPE score in a large cohort of liver transplant recipients with carbapenem-resistant Enterobacterales infection

Rinaldi M.
Primo
;
Bonazzetti C.;Gallo M.;Viale P.;Curti S.
Penultimo
;
Giannella M.
Ultimo
2023

Abstract

Background: Management of infections due to carbapenemase-resistant Enterobacterales (CRE) in solid organ transplant (SOT) recipients remains a difficult challenge. The INCREMENT-SOT-CPE score has been specifically developed from SOT recipients to stratify mortality risk, but an external validation is lacking.Methods: Multicenter retrospective cohort study of liver transplant (LT) recipients colonized with CRE infection who developed infection after transplant over 7-year period. Primary endpoint was all-cause 30-day mortality from infection onset. A comparison between INCREMENT-SOT-CPE and other selected scores was performed. A two-level mixed effects logistic regression model with random effects for the center was fitted. Performance characteristics at optimal cut-point were calculated. Multivariable Cox regression analysis of risk factors for all-cause 30-day mortality was carried out.Results: Overall, 250 CRE carriers developed infection after LT and were analyzed. The median age was 55 years (interquartile range [IQR]: 46-62) and 157 were males (62.8%). All-cause 30-day mortality was 35.6%. A sequential organ failure assessment (SOFA) score >= 11 showed a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 69.7%, 76.4%, 62.0%, 82.0%, and 74.0%, respectively. An INCREMENT-SOT-CPE >= 11 reported a sensitivity, specificity, PPV, NPV, and accuracy of 73.0%, 62.1%, 51.6%, 80.6% and 66.0%, respectively. At multivariable analysis acute renal failure, prolonged mechanical ventilation, INCREMENT-SOT-CPE score >= 11 and SOFA score >= 11 were independently associated with all-cause 30-day mortality, while a tigecycline-based targeted regimen was found to be protective.Conclusions: Both INCREMENT-SOT-CPE >= 11 and SOFA >= 11 were identified as strong predictors of all-cause 30-day mortality in a large cohort of CRE carriers developing infection after LT.
2023
Validation of the INCREMENT-SOT-CPE score in a large cohort of liver transplant recipients with carbapenem-resistant Enterobacterales infection / Rinaldi M.; Bonazzetti C.; Gallo M.; Ferraro G.; Freire M.; Terrabuio D.R.B.; Tandoi F.; Romagnoli R.; De Rosa F.G.; Mularoni A.; Ferrarese A.; Burra P.; Halpern M.; Balbi E.; Simkins J.; Abbo L.; Morrás I.; Cantero M.; Alagna L.; Bandera A.; Clemente W.T.; Valerio M.; Fernández A.; Muñoz P.; Statlender L.; Yahav D.; Camargo L.F.A.; Girão E.S.; Grossi P.; Viale P.; Curti S.; Giannella M.. - In: TRANSPLANT INFECTIOUS DISEASE. - ISSN 1398-2273. - ELETTRONICO. - 25:2(2023), pp. e14036.1-e14036.9. [10.1111/tid.14036]
Rinaldi M.; Bonazzetti C.; Gallo M.; Ferraro G.; Freire M.; Terrabuio D.R.B.; Tandoi F.; Romagnoli R.; De Rosa F.G.; Mularoni A.; Ferrarese A.; Burra P.; Halpern M.; Balbi E.; Simkins J.; Abbo L.; Morrás I.; Cantero M.; Alagna L.; Bandera A.; Clemente W.T.; Valerio M.; Fernández A.; Muñoz P.; Statlender L.; Yahav D.; Camargo L.F.A.; Girão E.S.; Grossi P.; Viale P.; Curti S.; Giannella M.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/927277
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