Palacios-Baena Zaira Raquel, Gutiérrez-Gutiérrez Belén, De Cueto Marina, Viale Pierluigi, Venditti Mario, Hernández-Torres Alicia, Oliver Antonio, Martínez-Martínez Luis, Calbo Esther, Pintado Vicente, Gasch Oriol, Almirante Benito, Antonio Lepe José, Pitout Johann, Akova Murat, Peña-Miralles Carmen, Schwaber Mitchell J, Tumbarello Mario, Tacconelli Evelina, Origüen Julia, Prim Nuria, Bou German, Giamarellou Helen, Bermejo Joaquín, Hamprecht Axel, Pérez Federico, Almela Manuel, Lowman Warren, Hsueh Po-Ren, Navarro-San Francisco Carolina, Torre-Cisneros Julián, Carmeli Yehuda, Bonomo Robert A, Paterson David L, Pascual Álvaro, Rodríguez-Baño Jesús
Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla-IBiS, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain.
Departamento de Microbiología, Universidad de Sevilla, Seville, Spain.
J Antimicrob Chemother. 2017 Mar 1;72(3):906-913. doi: 10.1093/jac/dkw513.
Bloodstream infections (BSIs) due to ESBL-producing Enterobacteriaceae (ESBL-E) are frequent yet outcome prediction rules for clinical use have not been developed. The objective was to define and validate a predictive risk score for 30 day mortality.
A multinational retrospective cohort study including consecutive episodes of BSI due to ESBL-E was performed; cases were randomly assigned to a derivation cohort (DC) or a validation cohort (VC). The main outcome variable was all-cause 30 day mortality. A predictive score was developed using logistic regression coefficients for the DC, then tested in the VC.
The DC and VC included 622 and 328 episodes, respectively. The final multivariate logistic regression model for mortality in the DC included age >50 years (OR = 2.63; 95% CI: 1.18-5.85; 3 points), infection due to Klebsiella spp. (OR = 2.08; 95% CI: 1.21-3.58; 2 points), source other than urinary tract (OR = 3.6; 95% CI: 2.02-6.44; 3 points), fatal underlying disease (OR = 3.91; 95% CI: 2.24-6.80; 4 points), Pitt score >3 (OR = 3.04; 95 CI: 1.69-5.47; 3 points), severe sepsis or septic shock at presentation (OR = 4.8; 95% CI: 2.72-8.46; 4 points) and inappropriate early targeted therapy (OR = 2.47; 95% CI: 1.58-4.63; 2 points). The score showed an area under the receiver operating curve (AUROC) of 0.85 in the DC and 0.82 in the VC. Mortality rates for patients with scores of < 11 and ≥11 were 5.6% and 45.9%, respectively, in the DC, and 5.4% and 34.8% in the VC.
We developed and validated an easy-to-collect predictive scoring model for all-cause 30 day mortality useful for identifying patients at high and low risk of mortality.
产超广谱β-内酰胺酶肠杆菌科细菌（ESBL-E）所致血流感染（BSIs）很常见，但尚未制定出临床可用的结局预测规则。目的是定义并验证一个30天死亡率的预测风险评分。
开展一项多国回顾性队列研究，纳入ESBL-E所致BSIs的连续发病病例；病例被随机分配到推导队列（DC）或验证队列（VC）。主要结局变量是全因30天死亡率。使用DC的逻辑回归系数制定一个预测评分，然后在VC中进行测试。
DC和VC分别纳入了622例和328例发病病例。DC中最终的死亡率多变量逻辑回归模型包括年龄>50岁（比值比[OR]=2.63；95%置信区间[CI]：1.18 - 5.85；3分）、肺炎克雷伯菌属感染（OR=2.08；95%CI：1.21 - 3.58；2分）、非尿路来源（OR=3.6；95%CI：2.02 - 6.44；3分）、致命基础疾病（OR=3.91；95%CI：2.24 - 6.80；4分）、Pitt评分>3（OR=3.04；95%CI：1.69 - 5.47；3分）、就诊时严重脓毒症或脓毒性休克（OR=4.8；95%CI：2.72 - 8.46；4分）以及不适当的早期靶向治疗（OR=2.47；95%CI：1.58 - 4.63；2分）。该评分在DC中的受试者工作特征曲线下面积（AUROC）为0.85，在VC中为0.82。DC中评分<11分和≥11分患者的死亡率分别为5.6%和45.9%，VC中分别为5.4%和34.8%。
我们开发并验证了一个易于收集的全因30天死亡率预测评分模型，有助于识别死亡风险高和低的患者。
