@article{3124095,
    title = "A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae",
    author = "Gutiérrez-Gutiérrez, B. and Salamanca, E. and de Cueto, M. and Pascual, A. and Rodríguez-Baño, J. and Hsueh, P.-R. and Viale, P. and Paño-Pardo, J.R. and Venditti, M. and Tumbarello, M. and Daikos, G. and Pintado, V. and Doi, Y. and Tuon, F.F. and Karaiskos, I. and Machuca, I. and Schwaber, M.J. and Azap, Ö.K. and Souli, M. and Roilides, E. and Pournaras, S. and Akova, M. and Pérez, F. and Bonomo, R.A. and Bermejo, J. and Oliver, A. and Almela, M. and Lowman, W. and Almirante, B. and Carmeli, Y. and Paterson, D.L. and Falcone, M. and Russo, A. and Giamarellou, H. and Trecarichi, E.M. and Losito, A.R. and García-Vázquez, E. and Hernández, A. and Gómez, J. and Iosifidis, E. and Prim, N. and Navarro, F. and Mirelis, B. and Origüen, J. and San Juan, R. and Fernández-Ruiz, M. and Larrosa, N. and Puig-Asensio, M. and Cisneros, J.M. and Molina, J. and González, V. and Rucci, V. and Ruiz de Gopegui, E. and Marinescu, C.I. and Martínez-Martínez, L. and Fariñas, M.C. and Cano, M.E. and Gozalo, M. and Mora-Rillo, M. and Navarro-San Francisco, C. and Peña, C. and Gómez-Zorrilla, S. and Tubau, F. and Tsakris, A. and Zarkotou, O. and Pitout, J. and Virmani, D. and Torre-Cisneros, J. and Natera, C. and Helvaci, Ö. and Sahin, A.O. and Cantón, R. and Ruiz, P. and Bartoletti, M. and Giannella, M. and Taconelli, E. and Riemenschneider, F. and Calbo, E. and Badia, C. and Xercavins, M. and Gasch, E. and Fontanals, D. and Jové, E.",
    journal = "Mayo Clinic Proceedings",
    year = "2016",
    volume = "91",
    number = "10",
    pages = "1362-1371",
    publisher = "Elsevier Ireland Ltd",
    issn = "0025-6196",
    doi = "10.1016/j.mayocp.2016.06.024",
    keywords = "adult;  aged;  antibiotic therapy;  Article;  biliary tract infection;  bloodstream infection;  carbapenemase producing Enterobacteriaceae;  cause of death;  Charlson Comorbidity Index;  cohort analysis;  controlled study;  female;  human;  major clinical study;  male;  mortality;  prediction;  predictive value;  retrospective study;  sensitivity and specificity;  sepsis;  shock;  urinary tract infection;  bacteremia;  clinical trial;  comorbidity;  decision support system;  Enterobacteriaceae;  Enterobacteriaceae Infections;  metabolism;  microbiology;  middle aged;  multicenter study;  statistical model;  validation study, antiinfective agent;  bacterial protein;  beta lactamase;  carbapenemase, Aged;  Anti-Bacterial Agents;  Bacteremia;  Bacterial Proteins;  beta-Lactamases;  Comorbidity;  Decision Support Techniques;  Enterobacteriaceae;  Enterobacteriaceae Infections;  Female;  Humans;  Logistic Models;  Male;  Middle Aged;  Predictive Value of Tests;  Retrospective Studies;  Sensitivity and Specificity",
    abstract = "Objective To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE). Patients and Methods A multinational retrospective cohort study (INCREMENT project) was performed from January 1, 2004, through December 31, 2013. Patients with clinically relevant monomicrobial BSIs due to CPE were included and randomly assigned to either a derivation cohort (DC) or a validation cohort (VC). The variables were assessed on the day the susceptibility results were available, and the predictive score was developed using hierarchical logistic regression. The main outcome variable was 14-day all-cause mortality. The predictive ability of the model and scores were measured by calculating the area under the receiver operating characteristic curve. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. Results The DC and VC included 314 and 154 patients, respectively. The final logistic regression model of the DC included the following variables: severe sepsis or shock at presentation (5 points); Pitt score of 6 or more (4 points); Charlson comorbidity index of 2 or more (3 points); source of BSI other than urinary or biliary tract (3 points); inappropriate empirical therapy and inappropriate early targeted therapy (2 points). The score exhibited an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.74-0.85) in the DC and 0.80 (95% CI, 0.73-0.88) in the VC. The results for 30-day all-cause mortality were similar. Conclusion A validated score predictive of early mortality in patients with BSIs due to CPE was developed. Trial Registration clinicaltrials.gov Identifier: NCT01 764490. © 2016 Mayo Foundation for Medical Education and Research"
}