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, Racioppi Agustina, Tula Lucas, 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, Carena Alberto Ángel
Centro de Educación Médica e Investigaciones Clínicas (CEMIC), Buenos Aires C1431, Argentina.
FUNDALEU, Buenos Aires C1114, Argentina.
Antibiotics (Basel). 2023 Jan 20;12(2):226. doi: 10.3390/antibiotics12020226.
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.
确定癌症和造血干细胞移植（HSCT）患者中耐碳青霉烯类肠杆菌科细菌（CRE）菌血症的风险因素，将有助于更早开始适当的经验性抗生素治疗。这是一项针对阿根廷12个中心的患者开展的前瞻性多中心观察性研究，这些患者患有癌症或接受了造血干细胞移植，并发生了肠杆菌科细菌菌血症。一个多重逻辑回归模型确定了CRE菌血症的风险因素，并根据回归系数制定了一个评分。该评分通过自助重采样技术进行了验证。共纳入443例肠杆菌科细菌菌血症患者：59例为CRE菌血症，384例为碳青霉烯类敏感肠杆菌科细菌（CSE）菌血症。确定的风险因素及其各自对应的分值为：菌血症发生前住院时间≥10天：比值比（OR）4.03，95%置信区间（CI）1.88 - 8.66（2分）；既往使用抗生素>7天：OR 4.65，95% CI 2.29 - 9.46（2分）；目前定植产KPC碳青霉烯酶的肠杆菌科细菌：OR 33.08，95% CI 11.74 - 93.25（5分）。以7分为临界值时，敏感性为35.59%，特异性为98.43%，阳性预测值（PPV）为77.7%，阴性预测值（NPV）为90.9%。该评分的总体表现令人满意（曲线下面积[AUC]为0.85，95% CI 0.80 - 0.91）。最后，无任何风险因素的患者发生CRE的检验后概率为1.9%，这几乎可以排除CRE菌血症的存在。
