title: Development and validation of the INCREMENT-ESBL predictive score for mortality in patients with bloodstream infections due to extended-spectrum-β-lactamase-producing Enterobacteriaceae.
abstract: 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.
authors.affiliation: 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.
authors.forename: Zaira Raquel
authors.initials: ZR
authors.lastname: Palacios-Baena
authors.affiliation: 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.
authors.forename: Belén
authors.initials: B
authors.lastname: Gutiérrez-Gutiérrez
authors.affiliation: 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.
authors.forename: Marina
authors.initials: M
authors.lastname: De Cueto
authors.affiliation: Teaching Hospital Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Viale
authors.affiliation: Policlinico Umberto I, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
authors.affiliation: Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.
authors.forename: Alicia
authors.initials: A
authors.lastname: Hernández-Torres
authors.affiliation: Hospital Universitario Son Espases, Palma de Mallorca, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Oliver
authors.affiliation: Hospital Universitario Marqués de Valdecilla-IDIVAL, Departamento de Biología Molecular, Universidad de Cantabria, Santander, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Martínez-Martínez
authors.affiliation: Hospital Universitari Mútua de Terrassa, Barcelona, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Calbo
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Pintado
authors.affiliation: Hospital Parc Taulí, Barcelona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Gasch
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Vall d'Hebrón, Barcelona, Spain.
authors.forename: Benito
authors.initials: B
authors.lastname: Almirante
authors.affiliation: 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.
authors.forename: José
authors.initials: J
authors.lastname: Antonio Lepe
authors.affiliation: University of Calgary, Calgary, Canada.
authors.forename: Johann
authors.initials: J
authors.lastname: Pitout
authors.affiliation: Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Akova
authors.affiliation: Hospital Universitari Bellvitge, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Peña-Miralles
authors.affiliation: Tel Aviv Sourasky Medical Center, National Center for Infection Control, Israel Ministry of Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Mitchell J
authors.initials: MJ
authors.lastname: Schwaber
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Tumbarello
authors.affiliation: Tübingen University Hospital and Center for Infection Research (DZIF), Tübingen, Germany.
authors.forename: Evelina
authors.initials: E
authors.lastname: Tacconelli
authors.affiliation: Unidad de Enfermedades Infecciosas, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Origüen
authors.affiliation: Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Prim
authors.affiliation: Complejo Hospitalario Universitario A Coruña, A Coruña, Spain.
authors.forename: German
authors.initials: G
authors.lastname: Bou
authors.affiliation: Hygeia General Hospital, Athens, Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Giamarellou
authors.affiliation: Hospital Español, Rosario, Argentina.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Bermejo
authors.affiliation: Institut für Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Köln, Cologne, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Hamprecht
authors.affiliation: Louis Stokes Cleveland Department of Veteran Affairs Medical Center, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Federico
authors.initials: F
authors.lastname: Pérez
authors.affiliation: Hospital Clinic, Barcelona, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Almela
authors.affiliation: Wits Donald Gordon Medical Centre, South Africa.
authors.forename: Warren
authors.initials: W
authors.lastname: Lowman
authors.affiliation: National Taiwan University Hospital, Taiwan.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.affiliation: Hospital La Paz, Madrid, Spain.
authors.forename: Carolina
authors.initials: C
authors.lastname: Navarro-San Francisco
authors.affiliation: Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Unidades de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Reina Sofia University Hospital and University of Córdoba, Córdoba, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Torre-Cisneros
authors.affiliation: Tel Aviv Sourasky Medical Center, National Center for Infection Control, Israel Ministry of Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Yehuda
authors.initials: Y
authors.lastname: Carmeli
authors.affiliation: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Departments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.affiliation: University of Queensland Centre for Clinical Research, Herston, Brisbane, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
authors.affiliation: 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.
authors.forename: Álvaro
authors.initials: Á
authors.lastname: Pascual
authors.affiliation: 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 Medicina, Universidad de Sevilla, Seville, Spain.
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*; D004755:Enterobacteriaceae / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality*; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000201:enzymology / Q000302:isolation & purification; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D018805:Sepsis / Q000188:drug therapy; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases