학술논문
Proposal of a clinical score to stratify the risk of multidrug-resistant gram-negative rods bacteremia in cancer patients.
Document Type
Academic Journal
Author
Carena AA; Centro de Educación Médica e Investigaciones Clínicas 'Norberto Quirno' CEMIC, Departamento de Medicina, División de Enfermedades Infecciosas, Buenos Aires, Argentina. Electronic address: alberto.carena390@gmail.com.; Laborde A; FUNDALEU, Departamento de Medicina, División de Enfermedades Infecciosas, Buenos Aires, Argentina.; Roccia-Rossi I; Hospital HIGA Gral. San Martín, Departamento de Medicina, División de Enfermedades Infecciosas, La Plata, Argentina.; Palacios CJ; Hospital HIGA Dr. Rodolfo Rossi, Departamento de Medicina, División de Enfermedades Infecciosas La Plata, Argentina.; Jordán R; Hospital Británico de Buenos Aires, Departamento de Medicina, División de Enfermedades Infecciosas. Buenos Aires, Argentina.; Valledor A; Hospital Italiano de Buenos Aires, Departamento de Medicina, División de Enfermedades Infecciosas, Buenos Aires, Argentina.; Nenna A; Hospital Municipal de Oncología Marie Curie, Departamento de Medicina, División de Enfermedades Infecciosas, Buenos Aires, Argentina.; Costantini P; Universidad de Buenos Aires, Instituto de Oncología Angel H. Roffo, Departamento de Medicina, División de Enfermedades Infecciosas, Buenos Aires, Argentina.; Dictar M; Instituto Alexander Fleming, División de Enfermedades Infecciosas, Departamento de Medicina, Buenos Aires, Argentina.; Herrera F; Centro de Educación Médica e Investigaciones Clínicas 'Norberto Quirno' CEMIC, Departamento de Medicina, División de Enfermedades Infecciosas, Buenos Aires, Argentina.
Source
Publisher: Elsevier Editora Country of Publication: Brazil NLM ID: 9812937 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1678-4391 (Electronic) Linking ISSN: 14138670 NLM ISO Abbreviation: Braz J Infect Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Multidrug-resistant gram-negative rods (MDR GNR) represent a growing threat for patients with cancer. Our objective was to determine the characteristics of and risk factors for MDR GNR bacteremia in patients with cancer and to develop a clinical score to predict MDR GNR bacteremia.
Material and Methods: Multicenter prospective study analyzing initial episodes of MDR GNR bacteremia. Risk factors were evaluated using a multiple logistic regression (forward-stepwise selection) analysis including variables with a p<0.10 in univariate analysis.
Results: 394 episodes of GNR bacteremia were included, with 168 (42.6 %) being MDR GNR. Five variables were identified as independent risk factors: recent antibiotic use (OR=2.8, 95 % CI 1.7-4.6, p=0.001), recent intensive care unit admission (OR=2.9, 95 % CI 1.1-7.8, p=0.027), hospitalization ≥ 7 days prior to the episode of bacteremia (OR=3.5, 95 % CI 2-6.2, p=0.005), severe mucositis (OR=5.3, 95 % CI 1.8-15.6, p=0.002), and recent or previous colonization/infection with MDR GNR (OR=2.3, 95 % CI 1.2-4.3, p=0.028). Using a cut-off value of two points, the score had a sensitivity of 66.07 % (95 % CI 58.4-73.2 %), a specificity of 77.8 % (95 % CI 71.4-82.7 %), a positive predictive value of 68 % (95 % CI 61.9-73.4 %), and a negative predictive value of 75.9 % (95 % CI 71.6-79.7 %). The overall performance of the score was satisfactory (AUROC 0.78; 95 % CI 0.73-0.82). In the cases with one or none of the risk factors identified, the negative likelihood ratio was 0.18 and the post-test probability of having MDR GNR was 11.68 %.
Conclusions: With the growing incidence of MDR GNR as etiologic agents of bacteremia in cancer patients, the development of this score could be a potential tool for clinicians.
(Copyright © 2019 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. All rights reserved.)
Material and Methods: Multicenter prospective study analyzing initial episodes of MDR GNR bacteremia. Risk factors were evaluated using a multiple logistic regression (forward-stepwise selection) analysis including variables with a p<0.10 in univariate analysis.
Results: 394 episodes of GNR bacteremia were included, with 168 (42.6 %) being MDR GNR. Five variables were identified as independent risk factors: recent antibiotic use (OR=2.8, 95 % CI 1.7-4.6, p=0.001), recent intensive care unit admission (OR=2.9, 95 % CI 1.1-7.8, p=0.027), hospitalization ≥ 7 days prior to the episode of bacteremia (OR=3.5, 95 % CI 2-6.2, p=0.005), severe mucositis (OR=5.3, 95 % CI 1.8-15.6, p=0.002), and recent or previous colonization/infection with MDR GNR (OR=2.3, 95 % CI 1.2-4.3, p=0.028). Using a cut-off value of two points, the score had a sensitivity of 66.07 % (95 % CI 58.4-73.2 %), a specificity of 77.8 % (95 % CI 71.4-82.7 %), a positive predictive value of 68 % (95 % CI 61.9-73.4 %), and a negative predictive value of 75.9 % (95 % CI 71.6-79.7 %). The overall performance of the score was satisfactory (AUROC 0.78; 95 % CI 0.73-0.82). In the cases with one or none of the risk factors identified, the negative likelihood ratio was 0.18 and the post-test probability of having MDR GNR was 11.68 %.
Conclusions: With the growing incidence of MDR GNR as etiologic agents of bacteremia in cancer patients, the development of this score could be a potential tool for clinicians.
(Copyright © 2019 Sociedade Brasileira de Infectologia. Published by Elsevier España, S.L.U. All rights reserved.)