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- Title
Development of a Clinical Score to Stratify the Risk for Carbapenem-Resistant Enterobacterales Bacteremia in Patients with Cancer and Hematopoietic Stem Cell Transplantation.
- Authors
Herrera, Fabián; Torres, Diego; Laborde, Ana; Berruezo, Lorena; Jordán, Rosana; Rossi, Inés Roccia; Valledor, Alejandra; Costantini, Patricia; Dictar, Miguel; Nenna, Andrea; Pereyra, María Laura; Lambert, Sandra; Benso, José; Poletta, Fernando; Gonzalez Ibañez, María Luz; Baldoni, Nadia; Eusebio, María José; Lovano, Fiorella; Barcán, Laura; Luck, Martín
- 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.
- Subjects
ARGENTINA; HEMATOPOIETIC stem cell transplantation; CANCER stem cells; DISEASE risk factors; BACTEREMIA; CANCER patients
- Publication
Antibiotics (2079-6382), 2023, Vol 12, Issue 2, p226
- ISSN
2079-6382
- Publication type
Article
- DOI
10.3390/antibiotics12020226