Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation
- Autores
- Herrera, Fabián; Torres, Diego; Laborde, Ana; Berruezo, Lorena; Jordán, Rosana; Roccia Rossi, Inés; Valledor, Alejandra; Costantini, Patricia; Dictar, Miguel; Nenna, Andrea; Pereyra, María Laura; Lambert, Sandra; Benso, José; Poletta, Fernando Adrián; Gonzalez Ibañez, María Luz; Baldoni, Nadia; Eusebio, María José; Lovano, Fiorella; Barcán, Laura; Luck, Martín; Racioppi, Agustina; Tula, Lucas Fernando; Pasterán, Fernando; Corso, Alejandra; Rapoport, Melina; Nicola, Federico; García Damiano, María Cristina; Carbone, Ruth; Monge, Renata; Reynaldi, Mariana; Greco, Graciela; Bronzi, Marcelo; Valle, Sandra; Chaves, María Laura; Vilches, Viviana; Blanco, Miriam Edith; Carena, Alberto Ángel
- Año de publicación
- 2023
- Idioma
- inglés
- Tipo de recurso
- artículo
- Estado
- versión publicada
- Descripción
- 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.
Fil: Herrera, Fabián. Centro de Educación Medica E Invest.clinicas; Argentina
Fil: Torres, Diego. Centro de Educación Medica E Invest.clinicas; Argentina
Fil: Laborde, Ana. Fundación Para Combatir la Leucemia; Argentina
Fil: Berruezo, Lorena. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; Argentina
Fil: Jordán, Rosana. Hospital Británico de Buenos Aires; Argentina
Fil: Roccia Rossi, Inés. Hospital International General Acute Gral San Martin; Argentina
Fil: Valledor, Alejandra. Hospital Italiano; Argentina
Fil: Costantini, Patricia. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina
Fil: Dictar, Miguel. Instituto Alexander Fleming; Argentina
Fil: Nenna, Andrea. Fundacion Marie Curie;
Fil: Pereyra, María Laura. Universidad Austral; Argentina
Fil: Lambert, Sandra. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina
Fil: Benso, José. Hospital Italiano; Argentina
Fil: Poletta, Fernando Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina
Fil: Gonzalez Ibañez, María Luz. Fundación Para Combatir la Leucemia; Argentina
Fil: Baldoni, Nadia. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; Argentina
Fil: Eusebio, María José. Hospital Británico de Buenos Aires; Argentina
Fil: Lovano, Fiorella. Hospital International General Acute Gral San Martin; Argentina
Fil: Barcán, Laura. Hospital Italiano; Argentina
Fil: Luck, Martín. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina
Fil: Racioppi, Agustina. Instituto Alexander Fleming; Argentina
Fil: Tula, Lucas Fernando. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina
Fil: Pasterán, Fernando. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; Argentina
Fil: Corso, Alejandra. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; Argentina
Fil: Rapoport, Melina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; Argentina
Fil: Nicola, Federico. Centro de Educación Medica E Invest.clinicas; Argentina
Fil: García Damiano, María Cristina. Fundación Para Combatir la Leucemia; Argentina
Fil: Carbone, Ruth. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; Argentina
Fil: Monge, Renata. Hospital Británico de Buenos Aires; Argentina
Fil: Reynaldi, Mariana. Hospital International General Acute Gral San Martin; Argentina
Fil: Greco, Graciela. Hospital Italiano; Argentina
Fil: Bronzi, Marcelo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina
Fil: Valle, Sandra. Instituto Alexander Fleming; Argentina
Fil: Chaves, María Laura. Fundacion Marie Curie;
Fil: Vilches, Viviana. Universidad Austral; Argentina
Fil: Blanco, Miriam Edith. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina
Fil: Carena, Alberto Ángel. Centro de Educación Medica E Invest.clinicas; Argentina - Materia
-
BACTEREMIA
CANCER
ENTEROBACTERALES
SCORE - Nivel de accesibilidad
- acceso abierto
- Condiciones de uso
- https://creativecommons.org/licenses/by/2.5/ar/
- Repositorio
.jpg)
- Institución
- Consejo Nacional de Investigaciones Científicas y Técnicas
- OAI Identificador
- oai:ri.conicet.gov.ar:11336/229089
Ver los metadatos del registro completo
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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 TransplantationHerrera, FabiánTorres, DiegoLaborde, AnaBerruezo, LorenaJordán, RosanaRoccia Rossi, InésValledor, AlejandraCostantini, PatriciaDictar, MiguelNenna, AndreaPereyra, María LauraLambert, SandraBenso, JoséPoletta, Fernando AdriánGonzalez Ibañez, María LuzBaldoni, NadiaEusebio, María JoséLovano, FiorellaBarcán, LauraLuck, MartínRacioppi, AgustinaTula, Lucas FernandoPasterán, FernandoCorso, AlejandraRapoport, MelinaNicola, FedericoGarcía Damiano, María CristinaCarbone, RuthMonge, RenataReynaldi, MarianaGreco, GracielaBronzi, MarceloValle, SandraChaves, María LauraVilches, VivianaBlanco, Miriam EdithCarena, Alberto ÁngelBACTEREMIACANCERENTEROBACTERALESSCOREhttps://purl.org/becyt/ford/3.1https://purl.org/becyt/ford/3Identifying 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.Fil: Herrera, Fabián. Centro de Educación Medica E Invest.clinicas; ArgentinaFil: Torres, Diego. Centro de Educación Medica E Invest.clinicas; ArgentinaFil: Laborde, Ana. Fundación Para Combatir la Leucemia; ArgentinaFil: Berruezo, Lorena. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; ArgentinaFil: Jordán, Rosana. Hospital Británico de Buenos Aires; ArgentinaFil: Roccia Rossi, Inés. Hospital International General Acute Gral San Martin; ArgentinaFil: Valledor, Alejandra. Hospital Italiano; ArgentinaFil: Costantini, Patricia. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; ArgentinaFil: Dictar, Miguel. Instituto Alexander Fleming; ArgentinaFil: Nenna, Andrea. Fundacion Marie Curie;Fil: Pereyra, María Laura. Universidad Austral; ArgentinaFil: Lambert, Sandra. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Benso, José. Hospital Italiano; ArgentinaFil: Poletta, Fernando Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; ArgentinaFil: Gonzalez Ibañez, María Luz. Fundación Para Combatir la Leucemia; ArgentinaFil: Baldoni, Nadia. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; ArgentinaFil: Eusebio, María José. Hospital Británico de Buenos Aires; ArgentinaFil: Lovano, Fiorella. Hospital International General Acute Gral San Martin; ArgentinaFil: Barcán, Laura. Hospital Italiano; ArgentinaFil: Luck, Martín. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; ArgentinaFil: Racioppi, Agustina. Instituto Alexander Fleming; ArgentinaFil: Tula, Lucas Fernando. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Pasterán, Fernando. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; ArgentinaFil: Corso, Alejandra. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; ArgentinaFil: Rapoport, Melina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; ArgentinaFil: Nicola, Federico. Centro de Educación Medica E Invest.clinicas; ArgentinaFil: García Damiano, María Cristina. Fundación Para Combatir la Leucemia; ArgentinaFil: Carbone, Ruth. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; ArgentinaFil: Monge, Renata. Hospital Británico de Buenos Aires; ArgentinaFil: Reynaldi, Mariana. Hospital International General Acute Gral San Martin; ArgentinaFil: Greco, Graciela. Hospital Italiano; ArgentinaFil: Bronzi, Marcelo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; ArgentinaFil: Valle, Sandra. Instituto Alexander Fleming; ArgentinaFil: Chaves, María Laura. Fundacion Marie Curie;Fil: Vilches, Viviana. Universidad Austral; ArgentinaFil: Blanco, Miriam Edith. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; ArgentinaFil: Carena, Alberto Ángel. Centro de Educación Medica E Invest.clinicas; ArgentinaMDPI2023-02info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttp://purl.org/coar/resource_type/c_6501info:ar-repo/semantics/articuloapplication/pdfapplication/pdfhttp://hdl.handle.net/11336/229089Herrera, Fabián; Torres, Diego; Laborde, Ana; Berruezo, Lorena; Jordán, Rosana; 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; MDPI; Antibiotics; 12; 2; 2-2023; 1-132079-6382CONICET DigitalCONICETenginfo:eu-repo/semantics/altIdentifier/doi/10.3390/antibiotics12020226info:eu-repo/semantics/openAccesshttps://creativecommons.org/licenses/by/2.5/ar/reponame:CONICET Digital (CONICET)instname:Consejo Nacional de Investigaciones Científicas y Técnicas2025-10-22T11:27:37Zoai:ri.conicet.gov.ar:11336/229089instacron:CONICETInstitucionalhttp://ri.conicet.gov.ar/Organismo científico-tecnológicoNo correspondehttp://ri.conicet.gov.ar/oai/requestdasensio@conicet.gov.ar; lcarlino@conicet.gov.arArgentinaNo correspondeNo correspondeNo correspondeopendoar:34982025-10-22 11:27:37.721CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicasfalse |
| dc.title.none.fl_str_mv |
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title |
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| spellingShingle |
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation Herrera, Fabián BACTEREMIA CANCER ENTEROBACTERALES SCORE |
| title_short |
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_full |
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_fullStr |
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_full_unstemmed |
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| title_sort |
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation |
| dc.creator.none.fl_str_mv |
Herrera, Fabián Torres, Diego Laborde, Ana Berruezo, Lorena Jordán, Rosana Roccia Rossi, Inés Valledor, Alejandra Costantini, Patricia Dictar, Miguel Nenna, Andrea Pereyra, María Laura Lambert, Sandra Benso, José Poletta, Fernando Adrián Gonzalez Ibañez, María Luz Baldoni, Nadia Eusebio, María José Lovano, Fiorella Barcán, Laura Luck, Martín Racioppi, Agustina Tula, Lucas Fernando Pasterán, Fernando Corso, Alejandra Rapoport, Melina Nicola, Federico García Damiano, María Cristina Carbone, Ruth Monge, Renata Reynaldi, Mariana Greco, Graciela Bronzi, Marcelo Valle, Sandra Chaves, María Laura Vilches, Viviana Blanco, Miriam Edith Carena, Alberto Ángel |
| author |
Herrera, Fabián |
| author_facet |
Herrera, Fabián Torres, Diego Laborde, Ana Berruezo, Lorena Jordán, Rosana Roccia Rossi, Inés Valledor, Alejandra Costantini, Patricia Dictar, Miguel Nenna, Andrea Pereyra, María Laura Lambert, Sandra Benso, José Poletta, Fernando Adrián Gonzalez Ibañez, María Luz Baldoni, Nadia Eusebio, María José Lovano, Fiorella Barcán, Laura Luck, Martín Racioppi, Agustina Tula, Lucas Fernando Pasterán, Fernando Corso, Alejandra Rapoport, Melina Nicola, Federico García Damiano, María Cristina Carbone, Ruth Monge, Renata Reynaldi, Mariana Greco, Graciela Bronzi, Marcelo Valle, Sandra Chaves, María Laura Vilches, Viviana Blanco, Miriam Edith Carena, Alberto Ángel |
| author_role |
author |
| author2 |
Torres, Diego Laborde, Ana Berruezo, Lorena Jordán, Rosana Roccia Rossi, Inés Valledor, Alejandra Costantini, Patricia Dictar, Miguel Nenna, Andrea Pereyra, María Laura Lambert, Sandra Benso, José Poletta, Fernando Adrián Gonzalez Ibañez, María Luz Baldoni, Nadia Eusebio, María José Lovano, Fiorella Barcán, Laura Luck, Martín Racioppi, Agustina Tula, Lucas Fernando Pasterán, Fernando Corso, Alejandra Rapoport, Melina Nicola, Federico García Damiano, María Cristina Carbone, Ruth Monge, Renata Reynaldi, Mariana Greco, Graciela Bronzi, Marcelo Valle, Sandra Chaves, María Laura Vilches, Viviana Blanco, Miriam Edith Carena, Alberto Ángel |
| author2_role |
author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author author |
| dc.subject.none.fl_str_mv |
BACTEREMIA CANCER ENTEROBACTERALES SCORE |
| topic |
BACTEREMIA CANCER ENTEROBACTERALES SCORE |
| purl_subject.fl_str_mv |
https://purl.org/becyt/ford/3.1 https://purl.org/becyt/ford/3 |
| dc.description.none.fl_txt_mv |
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. Fil: Herrera, Fabián. Centro de Educación Medica E Invest.clinicas; Argentina Fil: Torres, Diego. Centro de Educación Medica E Invest.clinicas; Argentina Fil: Laborde, Ana. Fundación Para Combatir la Leucemia; Argentina Fil: Berruezo, Lorena. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; Argentina Fil: Jordán, Rosana. Hospital Británico de Buenos Aires; Argentina Fil: Roccia Rossi, Inés. Hospital International General Acute Gral San Martin; Argentina Fil: Valledor, Alejandra. Hospital Italiano; Argentina Fil: Costantini, Patricia. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina Fil: Dictar, Miguel. Instituto Alexander Fleming; Argentina Fil: Nenna, Andrea. Fundacion Marie Curie; Fil: Pereyra, María Laura. Universidad Austral; Argentina Fil: Lambert, Sandra. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina Fil: Benso, José. Hospital Italiano; Argentina Fil: Poletta, Fernando Adrián. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina Fil: Gonzalez Ibañez, María Luz. Fundación Para Combatir la Leucemia; Argentina Fil: Baldoni, Nadia. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; Argentina Fil: Eusebio, María José. Hospital Británico de Buenos Aires; Argentina Fil: Lovano, Fiorella. Hospital International General Acute Gral San Martin; Argentina Fil: Barcán, Laura. Hospital Italiano; Argentina Fil: Luck, Martín. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina Fil: Racioppi, Agustina. Instituto Alexander Fleming; Argentina Fil: Tula, Lucas Fernando. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina Fil: Pasterán, Fernando. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; Argentina Fil: Corso, Alejandra. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; Argentina Fil: Rapoport, Melina. Dirección Nacional de Instituto de Investigación. Administración Nacional de Laboratorio e Instituto de Salud "Dr. C. G. Malbrán"; Argentina Fil: Nicola, Federico. Centro de Educación Medica E Invest.clinicas; Argentina Fil: García Damiano, María Cristina. Fundación Para Combatir la Leucemia; Argentina Fil: Carbone, Ruth. Gobierno de la Provincia de Buenos Aires. Ministerio de Salud. Hospital Interzonal General de Agudos "prof. Dr. Rodolfo Rossi".; Argentina Fil: Monge, Renata. Hospital Británico de Buenos Aires; Argentina Fil: Reynaldi, Mariana. Hospital International General Acute Gral San Martin; Argentina Fil: Greco, Graciela. Hospital Italiano; Argentina Fil: Bronzi, Marcelo. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Oncología "Ángel H. Roffo"; Argentina Fil: Valle, Sandra. Instituto Alexander Fleming; Argentina Fil: Chaves, María Laura. Fundacion Marie Curie; Fil: Vilches, Viviana. Universidad Austral; Argentina Fil: Blanco, Miriam Edith. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner Samic; Argentina Fil: Carena, Alberto Ángel. Centro de Educación Medica E Invest.clinicas; Argentina |
| description |
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. |
| publishDate |
2023 |
| dc.date.none.fl_str_mv |
2023-02 |
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info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion http://purl.org/coar/resource_type/c_6501 info:ar-repo/semantics/articulo |
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article |
| status_str |
publishedVersion |
| dc.identifier.none.fl_str_mv |
http://hdl.handle.net/11336/229089 Herrera, Fabián; Torres, Diego; Laborde, Ana; Berruezo, Lorena; Jordán, Rosana; 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; MDPI; Antibiotics; 12; 2; 2-2023; 1-13 2079-6382 CONICET Digital CONICET |
| url |
http://hdl.handle.net/11336/229089 |
| identifier_str_mv |
Herrera, Fabián; Torres, Diego; Laborde, Ana; Berruezo, Lorena; Jordán, Rosana; 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; MDPI; Antibiotics; 12; 2; 2-2023; 1-13 2079-6382 CONICET Digital CONICET |
| dc.language.none.fl_str_mv |
eng |
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eng |
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info:eu-repo/semantics/altIdentifier/doi/10.3390/antibiotics12020226 |
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CONICET Digital (CONICET) - Consejo Nacional de Investigaciones Científicas y Técnicas |
| repository.mail.fl_str_mv |
dasensio@conicet.gov.ar; lcarlino@conicet.gov.ar |
| _version_ |
1846781846553100288 |
| score |
12.982451 |