Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Infectious Diseases Unit, Hospital Universitario Reina Sofía, Universidad de Córdoba, Cordoba, Spain.
Infectious Diseases, Clinical Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen Macarena and Virgen del Rocío-IBiS, and Department of Medicine, Universidad de Sevilla, Seville, Spain.
Int J Antimicrob Agents. 2019 Oct;54(4):442-448. doi: 10.1016/j.ijantimicag.2019.07.017. Epub 2019 Aug 1.
External validation of the INCREMENT-CPE risk score (ICS) for 30-day all-cause mortality is needed. There is also scarce information about whether colistin resistance influences the prognosis of carbapenem-resistant Klebsiella pneumoniae (CRKp) bacteraemia. In this study, the ability of ICS to predict all-cause mortality in the KAPECOR cohort was calculated using the area under the receiver operating characteristic (AUROC) curve. The association of colistin resistance with mortality was studied. The ICS showed an AUROC curve of 0.77 (95% CI 0.68-0.86). A cut-off of 8 points showed 96.8% sensitivity and 50.7% specificity. Mortality of low-risk patients was not different in those treated with monotherapy versus combination therapy. However, mortality of high-risk patients treated with combination therapy (37.8%) was significantly lower than in those treated with monotherapy (68.4%) (P = 0.008). To study the prognostic significance of colistin resistance, 83 selected cases of bacteraemia due to colistin-susceptible CRKp were obtained from the INCREMENT cohort for comparison. Colistin resistance could not be shown to be associated with higher mortality in either the high-risk ICS group [adjusted odds ratio (aOR) = 1.56, 95% CI 0.69-3.33; P = 0.29] or in 37 ICS-matched pairs (aOR = 1.38, 95% CI 0.55-3.42; P = 0.49), or in a sensitivity analysis including only KPC isolates (aOR = 1.81, 95% CI 0.73-4.57; P = 0.20), but the precision of estimates was low. These results validate ICS for all-cause mortality and to optimise targeted therapy for CRKp bacteraemia. Colistin resistance was not clearly associated with increased mortality.
需要对 30 天全因死亡率的 INCREMENT-CPE 风险评分（ICS）进行外部验证。关于碳青霉烯类耐药肺炎克雷伯菌（CRKp）菌血症中多粘菌素耐药是否影响预后的信息也很少。在这项研究中，使用受试者工作特征曲线（ROC）下面积（AUROC）计算了 ICS 预测 KAPECOR 队列全因死亡率的能力。研究了多粘菌素耐药与死亡率的关系。ICS 的 AUROC 曲线为 0.77（95%CI 0.68-0.86）。截断值为 8 分，灵敏度为 96.8%，特异性为 50.7%。低危患者的死亡率在接受单药治疗与联合治疗的患者中没有差异。然而，高危患者接受联合治疗（37.8%）的死亡率明显低于接受单药治疗（68.4%）（P=0.008）。为了研究多粘菌素耐药的预后意义，从 INCREMENT 队列中获得了 83 例因多粘菌素敏感 CRKp 引起的菌血症的选定病例进行比较。在高危 ICS 组中，多粘菌素耐药与死亡率升高无关[校正比值比（aOR）=1.56，95%CI 0.69-3.33；P=0.29]，在 37 例 ICS 匹配对中也无关[aOR=1.38，95%CI 0.55-3.42；P=0.49]，或在仅包括 KPC 分离株的敏感性分析中也无关[aOR=1.81，95%CI 0.73-4.57；P=0.20]，但估计值的精度较低。这些结果验证了 ICS 对全因死亡率的预测，并优化了 CRKp 菌血症的靶向治疗。多粘菌素耐药与死亡率升高无明显关联。
