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dc.contributor.authorAzap, O. K.
dc.date.accessioned2020-11-09T19:44:57Z
dc.date.available2020-11-09T19:44:57Z
dc.date.issued2019
dc.identifier.issn0924-8579en_US
dc.identifier.urihttp://hdl.handle.net/11727/5022
dc.description.abstractExternal validation of the INCREMENT-CPE risk score (ICS) for 30-day all-cause mortality is needed. There is also scarce information about whether colistin resistance influences the prognosis of carbapenem-resistant Klebsiella pneumoniae (CRKp) bacteraemia. In this study, the ability of ICS to predict all-cause mortality in the KAPECOR cohort was calculated using the area under the receiver operating characteristic (AUROC) curve. The association of colistin resistance with mortality was studied. The ICS showed an AUROC curve of 0.77 (95% CI 0.68-0.86). A cut-off of 8 points showed 96.8% sensitivity and 50.7% specificity. Mortality of low-risk patients was not different in those treated with monotherapy versus combination therapy. However, mortality of high-risk patients treated with combination therapy (37.8%) was significantly lower than in those treated with monotherapy (68.4%) (P = 0.008). To study the prognostic significance of colistin resistance, 83 selected cases of bacteraemia due to colistin-susceptible CRKp were obtained from the INCREMENT cohort for comparison. Colistin resistance could not be shown to be associated with higher mortality in either the high-risk ICS group [adjusted odds ratio (aOR) = 1.56, 95% CI 0.69-3.33; P = 0.29] or in 37 ICS-matched pairs (aOR = 1.38, 95% CI 0.55-3.42; P = 0.49), or in a sensitivity analysis including only KPC isolates (aOR = 1.81, 95% CI 0.73-4.57; P = 0.20), but the precision of estimates was low. These results validate ICS for all-cause mortality and to optimise targeted therapy for CRKp bacteraemia. Colistin resistance was not clearly associated with increased mortality. (C) 2019 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.en_US
dc.language.isoengen_US
dc.relation.isversionof10.1016/j.ijantimicag.2019.07.017en_US
dc.rightsinfo:eu-repo/semantics/closedAccessen_US
dc.subjectKPCen_US
dc.subjectKlebsiella pneumoniaeen_US
dc.subjectCarbapenem resistanceen_US
dc.subjectINCREMENT risk scoreen_US
dc.subjectColistin resistanceen_US
dc.titleExternal validation of the INCREMENT-CPE mortality score in a carbapenem-resistant Klebsiella pneumoniae bacteraemia cohort: the prognostic significance of colistin resistanceen_US
dc.typearticleen_US
dc.relation.journalINTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTSen_US
dc.identifier.volume54en_US
dc.identifier.issue4en_US
dc.identifier.startpage442en_US
dc.identifier.endpage448en_US
dc.identifier.wos000487021400007en_US
dc.identifier.scopus2-s2.0-85071867109en_US
dc.contributor.pubmedID31377343en_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergien_US


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