aUnidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío-IBIS, Seville, SpainbNational Taiwan University Hospital, Taipei, TaiwancTeaching Hospital Policlinico S. Orsola Malpighi, Bologna, ItalydHospital Universitario La Paz-IDIPAZ, Madrid, SpaineHospital Clínico Universitario “Lozano Blesa”-IIS Aragón, Zaragoza, SpainfPoliclinico Umberto I, University of Rome La Sapienza, Rome, ItalygCatholic University of the Sacred Heart, Rome, ItalyhNational and Kapodistrian University of Athens, Laikon General Hospital, Athens, GreeceiHospital Ramón y Cajal, Madrid, SpainjUniversity of Pittsburgh, Pittsburgh, PAkHospital da Universidade Federal do Parana, Curitiba, BrazillHygeia General Hospital, Athens, GreecemHospital Universitario Reina Sofía-IMIBIC, Córdoba, SpainnTel Aviv Sourasky Medical Center, Tel Aviv, IsraeloBaskent University Faculty of Medicine, Ankara, TurkeypUniversity General Hospital Attikon, Chaidiri, GreeceqHippokration Hospital, Thessaloniki, GreecerMedical School, University of Thessaly, Larissa, GreecesHacettepe University School of Medicine, Ankara, TurkeytResearch Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OHuHospital Español, Rosario, ArgentinavHospital Universitario Son Espases, Palma de Mallorca, SpainwHospital Clinic, Barcelona, SpainxWits Donald Gordon Medical Centre, Johannesburg, South AfricayHospital Vall d'Hebrón, Barcelona, SpainzDepartments of Medicine, Pharmacology, Biochemistry, Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, OHaaDivision of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, IsraelbbNational Center for Infection Control, Israel Ministry of Health, Tel Aviv, IsraelccUniversity of Queensland Centre for Clinical Research, The University of Queensland, Herston, Brisbane, AustraliaddDepartamento de Microbiología, Universidad de Sevilla, Seville, SpaineeDepartamento de Medicina, Universidad de Sevilla, Seville, Spain
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Objective:To develop a score to predict mortality in patients with bloodstream infections (BSIs) due to carbapenemase-producing Enterobacteriaceae (CPE).Patients and Methods: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.Results: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.Conclusion:A validated score predictive of early mortality in patients with BSIs due to CPE was developed.Trial Registration:clinicaltrials.gov Identifier: NCT01 764490.