Development of a Risk Prediction Model for Carbapenem-Resistant Enterobacteriaceae Infection after Liver Transplantation: A Multinational Cohort Study

Maddalena Giannella; Maristela Freire; Matteo Rinaldi; Edson Abdala; Arianna Rubin; Alessandra Mularoni; Salvatore Gruttadauria; Paolo Grossi; Nour Shbaklo; Francesco Tandoi; Alberto Ferrarese; Patrizia Burra; Ruan Fernandes; Luis Fernando Aranha Camargo; Angel Asensio; Laura Alagna; Alessandra Bandera; Jacques Simkins; Lilian Abbo; Marcia Halpern; Evelyne Santana Girao; Maricela Valerio; Patricia Muñoz; Ainhoa Fernandez Yunquera; Liran Statlender; Dafna Yahav; Erica Franceschini; Elena Graziano; Maria Cristina Morelli; Matteo Cescon; Pierluigi Viale; Russell Lewis

doi:10.1093/cid/ciab109

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Development of a Risk Prediction Model for Carbapenem-Resistant Enterobacteriaceae Infection after Liver Transplantation: A Multinational Cohort Study

Journal article

Peer reviewed

Development of a Risk Prediction Model for Carbapenem-Resistant Enterobacteriaceae Infection after Liver Transplantation: A Multinational Cohort Study

Maddalena Giannella, Maristela Freire, Matteo Rinaldi, Edson Abdala, Arianna Rubin, Alessandra Mularoni, Salvatore Gruttadauria, Paolo Grossi, Nour Shbaklo, Francesco Tandoi, …

Clinical infectious diseases

2021-02-10

DOI: https://doi.org/10.1093/cid/ciab109

PMID: 33564840

Abstract

Abstract 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 sub-distribution hazard model, with death as competing event. A nomogram to predict 30- and 60-day CRE infection risk was created. Results 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 (IQR 9-42) days after LT. Pre-and post-LT colonization, multisite post-LT colonization, prolonged mechanical ventilation, acute renal injury, and surgical re-intervention 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 (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.

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Collaboration types: Domestic collaboration; International collaboration
Citation topics: 1 Clinical & Life Sciences; 1.23 Antibiotics & Antimicrobials; 1.23.146 Antibiotic Resistance
Web Of Science research areas: Immunology; Infectious Diseases; Microbiology
ESI research areas: Immunology

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Title: Development of a Risk Prediction Model for Carbapenem-Resistant Enterobacteriaceae Infection after Liver Transplantation: A Multinational Cohort Study
Creators: Maddalena Giannella - Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
Maristela Freire - Working Committee for Hospital Epidemiology and Infection Control, Hospital das Clinicas, Universidade de São Paulo, Brazil
Matteo Rinaldi - Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
Edson Abdala - Infectious diseases department, Hospital das Clinicas, Universidade de São Paulo, Brazil
Arianna Rubin - Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
Alessandra Mularoni - Infectious Diseases, ISMETT IRCCS, Palermo, Italy
Salvatore Gruttadauria - Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS, ISMETT-UPMC, Palermo, Italy
Paolo Grossi - Infectious and Tropical Diseases Department, University of Insubria, Varese, Italy
Nour Shbaklo - Infectious Disease, Department of Medical Sciences University of Turin AOU Città della salute e della Scienza, Turin, Italy
Francesco Tandoi - Liver Transplant Center, General Surgery Unit, Department of Surgical Sciences, A.O.U. Città della Salute e della Scienza, Molinette Hospital, University of Turin, Turin, Italy
Alberto Ferrarese - Multivisceral Transplant Unit (Gastroenterology), Department of Surgery Oncology and Gastroenterology, Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
Patrizia Burra - Multivisceral Transplant Unit (Gastroenterology), Department of Surgery Oncology and Gastroenterology, Surgical and Gastroenterological Sciences, Padua University Hospital, Padua, Italy
Ruan Fernandes - Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Luis Fernando Aranha Camargo - Infectious Diseases Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil
Angel Asensio - Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Madrid, Spain
Laura Alagna - Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Alessandra Bandera - Infectious Diseases Unit, Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
Jacques Simkins - Transplant Infectious Diseases and Immunocompromised Host Service, Division of Infectious Diseases, University of Miami/Miami Transplant Institute, Miami, Florida, USA
Lilian Abbo - Department of Medicine, Division of Infectious Diseases, University of Miami, Miami, Florida, USA
Marcia Halpern - Liver Transplant Unit, Quinta D’Or Hospital, Rio de Janeiro, Brazil
Evelyne Santana Girao - Infectious Diseases Unit and Liver Transplant Unit of Hospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza- Brazil
Maricela Valerio - Department of Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Patricia Muñoz - Department of Clinical Microbiology and Infectious Diseases, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Ainhoa Fernandez Yunquera - Department of Gastroenterology, Instituto de Investigación Sanitaria Gregorio Marañón, Hospital General Universitario Gregorio Marañón, Madrid, Spain
Liran Statlender - Intensive Care Unit, Rabin Medical Center, Petah Tikva, Israel
Dafna Yahav - Infectious Disease Unit, Beilinson Hospital, Petah Tikva, Israel
Erica Franceschini - Infectious Diseases Unit, Department of Nephrology Dialysis and Transplant Unit, University Hospital of Modena, Modena, Italy
Elena Graziano - Infectious Disease Clinic, ASUFC, Udine, Italy
Maria Cristina Morelli - Internal Medicine Unit for the Treatment of Severe Organ Failure, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy
Matteo Cescon - Liver and Multiorgan Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
Pierluigi Viale - Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
Russell Lewis - Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna, Italy, Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
Publication Details: Clinical infectious diseases
Academic Unit: Miller School of Medicine; UMMG Dept of Medicine - Infectious Diseases
Language: English
Resource Type: Journal article
PMID: 33564840
Record Identifier: 991031597622002976