TY - JOUR
T1 - Development of a Risk Prediction Model for Carbapenem-resistant Enterobacteriaceae Infection after Liver Transplantation
T2 - A Multinational Cohort Study
AU - Giannella, Maddalena
AU - Freire, Maristela
AU - Rinaldi, Matteo
AU - Abdala, Edson
AU - Rubin, Arianna
AU - Mularoni, Alessandra
AU - Gruttadauria, Salvatore
AU - Grossi, Paolo
AU - Shbaklo, Nour
AU - Tandoi, Francesco
AU - Ferrarese, Alberto
AU - Burra, Patrizia
AU - Fernandes, Ruan
AU - Aranha Camargo, Luis Fernando
AU - Asensio, Angel
AU - Alagna, Laura
AU - Bandera, Alessandra
AU - Simkins, Jacques
AU - Abbo, Lilian
AU - Halpern, Marcia
AU - Santana Girao, Evelyne
AU - Valerio, Maricela
AU - Muñoz, Patricia
AU - Fernandez Yunquera, Ainhoa
AU - Statlender, Liran
AU - Yahav, Dafna
AU - Franceschini, Erica
AU - Graziano, Elena
AU - Morelli, Maria Cristina
AU - Cescon, Matteo
AU - Viale, Pierluigi
AU - Lewis, Russell
AU - Bartoletti, Michele
AU - Pascale, Renato
AU - Campoli, Caterina
AU - Coladonato, Simona
AU - Cristini, Francesco
AU - Tumietto, Fabio
AU - Siniscalchi, Antonio
AU - Laici, Cristiana
AU - Ambretti, Simone
AU - Romagnoli, Renato
AU - De Rosa, Francesco Giuseppe
AU - Muscatello, Antonio
AU - Mangioni, Davide
AU - Gori, Andrea
AU - Antonelli, Barbara
AU - Dondossola, Daniele
AU - Rossi, Giorgio
AU - Invernizzi, Federica
AU - Peghin, Maddalena
AU - Cillo, Umberto
AU - Mussini, Cristina
AU - Benedetto, Fabrizio Di
AU - Terrabuio, Débora Raquel Benedita
AU - Bittante, Carolina D.
AU - Toniolo, Alexandra Do Rosário
AU - Balbi, Elizabeth
AU - Garcia, José Huygens Parente
AU - Morrás, Ignacio
AU - Ramos, Antonio
AU - Cruz, Ana Fernandez
AU - Salcedo, Magdalena
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved.
PY - 2021/8/15
Y1 - 2021/8/15
N2 - Background: Patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) are at higher risk of developing CRE infection after liver transplantation (LT), with associated high morbidity and mortality. Prediction model for CRE infection after LT among carriers could be useful to target preventive strategies. Methods: Multinational multicenter cohort study of consecutive adult patients underwent LT and colonized with CRE before or after LT, from January 2010 to December 2017. Risk factors for CRE infection were analyzed by univariate analysis and by Fine-Gray subdistribution hazard model, with death as competing event. A nomogram to predict 30- and 60-day CRE infection risk was created. Results: A total of 840 LT recipients found to be colonized with CRE before (n = 203) or after (n = 637) LT were enrolled. CRE infection was diagnosed in 250 (29.7%) patients within 19 (interquartile range [IQR], 9-42) days after LT. Pre- and post-LT colonization, multisite post-LT colonization, prolonged mechanical ventilation, acute renal injury, and surgical reintervention were retained in the prediction model. Median 30- and 60-day predicted risk was 15% (IQR, 11-24) and 21% (IQR, 15-33), respectively. Discrimination and prediction accuracy for CRE infection was acceptable on derivation (area under the curve [AUC], 74.6; Brier index, 16.3) and bootstrapped validation dataset (AUC, 73.9; Brier index, 16.6). Decision-curve analysis suggested net benefit of model-directed intervention over default strategies (treat all, treat none) when CRE infection probability exceeded 10%. The risk prediction model is freely available as mobile application at https://idbologna.shinyapps.io/CREPostOLTPredictionModel/. Conclusions: Our clinical prediction tool could enable better targeting interventions for CRE infection after transplant.
AB - Background: Patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) are at higher risk of developing CRE infection after liver transplantation (LT), with associated high morbidity and mortality. Prediction model for CRE infection after LT among carriers could be useful to target preventive strategies. Methods: Multinational multicenter cohort study of consecutive adult patients underwent LT and colonized with CRE before or after LT, from January 2010 to December 2017. Risk factors for CRE infection were analyzed by univariate analysis and by Fine-Gray subdistribution hazard model, with death as competing event. A nomogram to predict 30- and 60-day CRE infection risk was created. Results: A total of 840 LT recipients found to be colonized with CRE before (n = 203) or after (n = 637) LT were enrolled. CRE infection was diagnosed in 250 (29.7%) patients within 19 (interquartile range [IQR], 9-42) days after LT. Pre- and post-LT colonization, multisite post-LT colonization, prolonged mechanical ventilation, acute renal injury, and surgical reintervention were retained in the prediction model. Median 30- and 60-day predicted risk was 15% (IQR, 11-24) and 21% (IQR, 15-33), respectively. Discrimination and prediction accuracy for CRE infection was acceptable on derivation (area under the curve [AUC], 74.6; Brier index, 16.3) and bootstrapped validation dataset (AUC, 73.9; Brier index, 16.6). Decision-curve analysis suggested net benefit of model-directed intervention over default strategies (treat all, treat none) when CRE infection probability exceeded 10%. The risk prediction model is freely available as mobile application at https://idbologna.shinyapps.io/CREPostOLTPredictionModel/. Conclusions: Our clinical prediction tool could enable better targeting interventions for CRE infection after transplant.
KW - CRE carriage
KW - CRE infection
KW - SOT
KW - liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=85114350736&partnerID=8YFLogxK
U2 - 10.1093/cid/ciab109
DO - 10.1093/cid/ciab109
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C2 - 33564840
AN - SCOPUS:85114350736
SN - 1058-4838
VL - 73
SP - E955-E966
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 4
ER -