title: A Predictive Model of Mortality in Patients With Bloodstream Infections due to Carbapenemase-Producing Enterobacteriaceae.
abstract: To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE).
  
  
  
  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.
  
  
  
  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.
  
  
  
  A validated score predictive of early mortality in patients with BSIs due to CPE was developed.
  
  
  
  clinicaltrials.gov Identifier: NCT01 764490.
authors.affiliation: Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain.
authors.forename: Belén
authors.initials: B
authors.lastname: Gutiérrez-Gutiérrez
authors.affiliation: Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Salamanca
authors.affiliation: Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: de Cueto
authors.affiliation: National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.affiliation: Teaching Hospital Policlinico S. Orsola Malpighi, Bologna, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.affiliation: Hospital Universitario La Paz-IDIPAZ, Madrid, Spain; Hospital Clínico Universitario "Lozano Blesa"-IIS Aragón, Zaragoza, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Paño-Pardo
authors.affiliation: Policlinico Umberto I, University of Rome La Sapienza, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
authors.affiliation: National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Daikos
authors.affiliation: Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pintado
authors.affiliation: University of Pittsburgh, Pittsburgh, PA.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Doi
authors.affiliation: Hospital da Universidade Federal do Parana, Curitiba, Brazil.
authors.forename: Felipe Francisco
authors.initials: FF
authors.lastname: Tuon
authors.affiliation: Hygeia General Hospital, Athens, Greece.
authors.forename: Ilias
authors.initials: I
authors.lastname: Karaiskos
authors.affiliation: Hospital Universitario Reina Sofía-IMIBIC, Córdoba, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Machuca
authors.affiliation: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
authors.affiliation: Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Özlem Kurt
authors.initials: ÖK
authors.lastname: Azap
authors.affiliation: University General Hospital Attikon, Chaidiri, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Souli
authors.affiliation: Hippokration Hospital, Thessaloniki, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
authors.affiliation: Medical School, University of Thessaly, Larissa, Greece.
authors.forename: Spyros
authors.initials: S
authors.lastname: Pournaras
authors.affiliation: Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Akova
authors.affiliation: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH.
authors.forename: Federico
authors.initials: F
authors.lastname: Pérez
authors.affiliation: Hospital Español, Rosario, Argentina.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Bermejo
authors.affiliation: Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliver
authors.affiliation: Hospital Clinic, Barcelona, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Almela
authors.affiliation: Wits Donald Gordon Medical Centre, Johannesburg, South Africa.
authors.forename: Warren
authors.initials: W
authors.lastname: Lowman
authors.affiliation: Hospital Vall d'Hebrón, Barcelona, Spain.
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.affiliation: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH; Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.affiliation: Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; National Center for Infection Control, Israel Ministry of Health, Tel Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: University of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
authors.affiliation: Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain; Departamento de Microbiología, Universidad de Sevilla, Seville, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Pascual
authors.affiliation: Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, Spain; Departamento de Medicina, Universidad de Sevilla, Seville, Spain. Electronic address: jesusrb@us.es.
authors.forename: Jesús
authors.initials: J
authors.lastname: Rodríguez-Baño
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D001426:Bacterial Proteins / Q000378:metabolism*; D015897:Comorbidity; D003661:Decision Support Techniques; D004755:Enterobacteriaceae / Q000378:metabolism*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000401:mortality*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase