Risks of Infection and Mortality Among Patients Colonized With Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae : Validation of Scores and Proposal for Management
Background: The management and indication of empiric treatment in Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp)-colonized patients should be improved.
Methods: A prospective cohort of 94 patients colonized by KPC-Kp was followed for 90 days to validate (i) the Giannella risk score (GRS) to predict the development of any type of KPC-Kp infection and (ii) the INCREMENT-CPE score (ICS) to predict 30-day mortality in patients with infection. Both scores were combined to recommend appropriate empiric treatment. The predictive ability of the scores was measured by calculating the area under the receiver operating characteristic (AUROC) curve.
Results: The GRS showed an AUROC curve for infection due to KPC-Kp of 0.92 (95% confidence interval [CI], .87-.98). The optimal cutoff point was fixed at <7 and ≥7 (92.9% sensitivity, 84.8% specificity); infection developed in 6.3% patients in the 0-6 GRS group and in 84.8% patient in the ≥7 GRS group. According to the ICS, the severity of the infection was also significantly higher in the ≥7 GRS group. The ICS showed an AUROC of 0.78 (95% CI, .65-.91) for 30-day all-cause mortality among patients with infection. A classification and regression tree analysis confirmed the GRS cutoff point at 7, and selected ≥12 points to predict a KPC-Kp infection with a high ICS.
Conclusions: Our results validate the GRS and ICS for indicating empiric therapy in KPC-Kp-colonized patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:66 |
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| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - 66(2018), 8 vom: 03. Apr., Seite 1204-1210 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Cano, Angela [VerfasserIn] |
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| Links: |
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| Themen: |
Bacterial Proteins |
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| Anmerkungen: |
Date Completed 25.10.2019 Date Revised 08.04.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.1093/cid/cix991 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM277928869 |
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| 100 | 1 | |a Cano, Angela |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Risks of Infection and Mortality Among Patients Colonized With Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae |b Validation of Scores and Proposal for Management |
| 264 | 1 | |c 2018 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 25.10.2019 | ||
| 500 | |a Date Revised 08.04.2022 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Background: The management and indication of empiric treatment in Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp)-colonized patients should be improved | ||
| 520 | |a Methods: A prospective cohort of 94 patients colonized by KPC-Kp was followed for 90 days to validate (i) the Giannella risk score (GRS) to predict the development of any type of KPC-Kp infection and (ii) the INCREMENT-CPE score (ICS) to predict 30-day mortality in patients with infection. Both scores were combined to recommend appropriate empiric treatment. The predictive ability of the scores was measured by calculating the area under the receiver operating characteristic (AUROC) curve | ||
| 520 | |a Results: The GRS showed an AUROC curve for infection due to KPC-Kp of 0.92 (95% confidence interval [CI], .87-.98). The optimal cutoff point was fixed at <7 and ≥7 (92.9% sensitivity, 84.8% specificity); infection developed in 6.3% patients in the 0-6 GRS group and in 84.8% patient in the ≥7 GRS group. According to the ICS, the severity of the infection was also significantly higher in the ≥7 GRS group. The ICS showed an AUROC of 0.78 (95% CI, .65-.91) for 30-day all-cause mortality among patients with infection. A classification and regression tree analysis confirmed the GRS cutoff point at 7, and selected ≥12 points to predict a KPC-Kp infection with a high ICS | ||
| 520 | |a Conclusions: Our results validate the GRS and ICS for indicating empiric therapy in KPC-Kp-colonized patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Validation Study | |
| 650 | 7 | |a Bacterial Proteins |2 NLM | |
| 650 | 7 | |a beta-Lactamases |2 NLM | |
| 650 | 7 | |a EC 3.5.2.6 |2 NLM | |
| 650 | 7 | |a carbapenemase |2 NLM | |
| 650 | 7 | |a EC 3.5.2.6 |2 NLM | |
| 700 | 1 | |a Gutiérrez-Gutiérrez, Belén |e verfasserin |4 aut | |
| 700 | 1 | |a Machuca, Isabel |e verfasserin |4 aut | |
| 700 | 1 | |a Gracia-Ahufinger, Irene |e verfasserin |4 aut | |
| 700 | 1 | |a Pérez-Nadales, Elena |e verfasserin |4 aut | |
| 700 | 1 | |a Causse, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Castón, Juan José |e verfasserin |4 aut | |
| 700 | 1 | |a Guzman-Puche, Julia |e verfasserin |4 aut | |
| 700 | 1 | |a Torre-Giménez, Julian |e verfasserin |4 aut | |
| 700 | 1 | |a Kindelán, Lara |e verfasserin |4 aut | |
| 700 | 1 | |a Martínez-Martinez, Luis |e verfasserin |4 aut | |
| 700 | 1 | |a Rodriguez-Baño, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Torre-Cisneros, Julian |e verfasserin |4 aut | |
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