Treatment of carbapenemase-producing Enterobacterales bloodstream infections in solid organ transplant recipients is challenging. The objective of this study was to develop a specific score to predict mortality in solid organ transplant recipients with carbapenemase-producing Enterobacterales bloodstream infections. A multinational, retrospective (2004-2016) cohort study (INCREMENT-SOT, ClinicalTrials.gov NCT02852902) was performed. The main outcome variable was 30-day all-cause mortality. The INCREMENT-SOT-CPE score was developed using logistic regression. The global cohort included 216 patients. The final logistic regression model included the following variables: INCREMENT-CPE mortality score ≥8 (8 points), no source control (3 points), inappropriate empirical therapy (2 points), cytomegalovirus disease (7 points), lymphopenia (4 points), and the interaction between INCREMENT-CPE score ≥8 and CMV disease (minus 7 points). This score showed an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] 0.76-0.88) and classified patients into 3 strata: 0-7 (low mortality), 8-11 (high mortality), and 12-17 (very-high mortality). We performed a stratified analysis of the effect of monotherapy vs combination therapy among 165 patients who received appropriate therapy. Monotherapy was associated with higher mortality only in the very-high (adjusted hazard ratio [HR] 2.82, 95% CI 1.13-7.06, P = .03) and high (HR 9.93, 95% CI 2.08-47.40, P = .004) mortality risk strata. A score-based algorithm is provided for therapy guidance.

中文翻译：

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实体器官移植受者因产碳青霉烯酶肠杆菌引起血流感染的死亡率预测因素：巨细胞病毒病和淋巴细胞减少症的影响。


实体器官移植受者中产生碳青霉烯酶的肠杆菌血流感染的治疗具有挑战性。本研究的目的是制定一个具体的评分来预测患有产碳青霉烯酶肠杆菌血流感染的实体器官移植受者的死亡率。进行了一项多国回顾性（2004-2016）队列研究（INCRMENT-SOT，ClinicalTrials.gov NCT02852902）。主要结果变量是 30 天全因死亡率。 INCRMENT-SOT-CPE 评分是使用逻辑回归得出的。全球队列包括 216 名患者。最终的逻辑回归模型包括以下变量：INCRMENT-CPE死亡率评分≥8（8分）、无源头控制（3分）、不适当的经验治疗（2分）、巨细胞病毒病（7分）、淋巴细胞减少（4分） ，以及 INCREMENT-CPE 评分≥8 与 CMV 疾病之间的交互作用（负 7 分）。该评分显示受试者工作特征曲线下面积为 0.82（95% 置信区间 [CI] 0.76-0.88），并将患者分为 3 级：0-7（低死亡率）、8-11（高死亡率）和 12 -17（死亡率非常高）。我们对 165 名接受适当治疗的患者进行了单一疗法与联合疗法的效果分层分析。仅在极高死亡率（调整后风险比 [HR] 2.82，95% CI 1.13-7.06，P = .03）和高死亡率（HR 9.93，95% CI 2.08-47.40，P = .004）中，单一疗法与较高死亡率相关。 ) 死亡风险层。提供基于评分的算法用于治疗指导。