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Tipo:	Artigo de Periódico
Título:	Predictors of mortality in solid organ transplant recipients with bloodstream infections due to carbapenemase-producing Enterobacterales: The impact of cytomegalovirus disease and lymphopenia
Autor(es):	Elenapérez'nadales Ranganathan n. Iyer z. Koçak Tufan e. Kazak m. David e. Lease n. Nestorova g. Cornaglia m. Akova Seema Metha Elisa Grazia Calvi E.m. Seminari Maristela Pinheiro Freire j. Carratalá a. Domínguez e. Cordero J.a. Lepe m. Montejo e. Merino de Lucas B.m. Eriksson c. Van Delden o. Manuel h. Arslan Mario Tumbarello Marco Falcone Mario Fernández'ruiz José María Costa'mateo Meenakshi m. Rana Tania Mara Varejão Strabelli Mical Paul Belén Gutiérrez'gutiérrez María Carmen Fariñas Wanessa Trindade Clemente Emmanuel Roilides Patricia Muñoz García Laurent Dewispelaere Belén Loeches Warren Lowman Ban Hock Tan Rosa Escudero'sánchez Marta Bodro Marimont Alejandra m. Natera Paolo Antonio Grossi Fabio Soldani Filiz Gunseren Nina Nestorova Álvaro Pascual Luis Martínez'martínez José María Aguado Jesús Rodríguez'baño Julián Torre'cisneros A.t. Wan Song Edson Abdala w. Andraus L.a. Carneiro D'albuquerque e. David'neto f. Jota de Paula f. Rossi d. Ostrander r. Avery m. Rizzi A.r. Losito f. Raffaelli Maira Reina Magalhães p. Del Giacomo g. Tiseo j. Lora'tamayo r San'juan i. Gracia'ahufinger j. Castón Y.a. Ruiz D.r. Altman S.v. Campos n. Bar'sinai Alessandra Mularoni f. Koppel f. Arnaiz de Las Revillas Almajano c. González Rico m. Fernández Martínez P.h.o. Mourão F.a. Neves Janita Ferreira a. Pyrpasopoulou e. Iosifidis i. Romiopoulos Francesco Monaco M.v. Minero c Sánchez'carrillo s. Lardo j. Coussement m. Dodémont k. Jiayun p. Martín'dávila j. Fortún m. Almela a. Moreno Ligia Camera Pierrotti l. Linares D.d. Gasperina M.l. Balsamo c Rovelli e. Concia s. Chiesi D.n. Salerno d. Ogunc b. Pilmis
Resumen:	Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multina tional, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the fol lowing variables: INCREMENT-CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operat ing characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combi nation therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortal ity risk strata. A score-based algorithm is provided for therapy guidance.
Asunto:	Farmacorresistência Fúngica Pesquisa em Enfermagem Clínica Infectologia Transplante de orgãos
Idioma:	eng
País:	Brasil
Editor:	Universidade Federal de Minas Gerais
Sigla da Institución:	UFMG
Departamento:	MED - DEPARTAMENTO DE PROPEDÊUTICA COMPLEMENTAR
Tipo de acceso:	Acesso Aberto
Identificador DOI:	10.1111/ajt.15769
URI:	http://hdl.handle.net/1843/55714
Fecha del documento:	2019
metadata.dc.url.externa:	https://www.sciencedirect.com/science/article/pii/S1600613522223624?via%3Dihub
metadata.dc.relation.ispartof:	American Journal of Transplantation
Aparece en las colecciones:	Artigo de Periódico

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