OP-4 DEVELOPMENT AND EXTERNAL VALIDATION OF A MODEL TO PREDICT MULTI-DRUG RESISTANT BACTERIAL INFECTIONS IN PATIENTS WITH CIRRHOSIS

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Medical College, Cuttack, India" "etiqueta" => "17" "identificador" => "aff0017" ] 17 => array:3 [ "entidad" => "Liver Unit, Hospital Central de las Fuerzas Armadas y el Programa Nacional de Trasplante Hepático, Montevideo, Uruguay" "etiqueta" => "18" "identificador" => "aff0018" ] 18 => array:3 [ "entidad" => "Liver Unit, Hospital Aleman, Buenos Aires, Argentina" "etiqueta" => "19" "identificador" => "aff0019" ] 19 => array:3 [ "entidad" => "Liver Unit, Hospital Privado de Rosario, Rosario, Argentina" "etiqueta" => "20" "identificador" => "aff0020" ] 20 => array:3 [ "entidad" => "Liver Unit, Hospital Universitario Austral, Buenos Aires, Argentina" "etiqueta" => "21" "identificador" => "aff0021" ] 21 => array:3 [ "entidad" => "Digestive Disease and Oncology Centre, Medistra Hospital, Jakarta, Indonesia" "etiqueta" => "22" "identificador" => "aff0022" ] 22 => array:3 [ "entidad" => "Gastroenterology Unit, Hospital Valdivia, Valdivia, Chile" "etiqueta" => "23" "identificador" => "aff0023" ] 23 => array:3 [ "entidad" => "Division of Gastroenterology, Department of Medicine, University of Toronto, Ontario, Canadá" "etiqueta" => "24" "identificador" => "aff0024" ] 24 => array:3 [ "entidad" => "Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, Francia" "etiqueta" => "25" "identificador" => "aff0025" ] ] ] ] "textoCompleto" => "<elsevierMultimedia ident="fig0001"></elsevierMultimedia>" "pdfFichero" => "main.pdf" "tienePdf" => true "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "resumen" => "Introduction and ObjectivesEmpirical antibiotic treatment for suspected infections in cirrhosis is crucial. This study aimed to develop and validate a model to predict the probability of infections by multi-drug resistant organisms (MDRO) in patients with cirrhosis. Materials and MethodsCross-sectional study (NCT05641025) of in-patients with bacterial infections from two prospective studies. A global transcontinental study was used for model development and internal validation (n = 1,302), and a study from Argentina and Uruguay (n=472) was used for external validation. Infection by MDROs was defined as an infection caused by at least one bacteria with acquired resistance to at least one antibiotic of three different families. A stepwise selection process was used for model development and bootstrapping for internal validation. ResultsThe prevalence of infection by MDROs was 19% in the development and 22% in the external validation dataset. Most frequent infections were spontaneous bacterial peritonitis (SBP) and urinary tract infection (UTI). Half of the infections were community-acquired, and half were equally distributed among healthcare-associated and nosocomial origin. The model predictors are shown in the figure. Very good calibration was achieved in internal and external validation (Figure). Discrimination was adequate: area under the receiver operating characteristic curve (AUROC) of 0.73 (95% CI: 0.69 - 0.76) in internal validation and 0.67 (95% CI: 0.62 - 0.74) in external validation. When applying a probability cut-off point of 5% to the external dataset, a negative predictive value (NPV) of 93% (95% CI: 84% - 98%) was observed. ConclusionsThis easy-to-implement model achieved adequate performance for predicting infections by MDROs in patients with cirrhosis, offering costless bedside individualized risk estimates that might improve the selection of empiric antibiotics. Its high NPV suggests that it could be used as a rule-out tool, particularly in patients at higher risk of infection by MDROs, reducing the use of broad- spectrum antibiotics." 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Sebastian Marciano1, Salvatore Piano2, Virendra Singh3, Paolo Caraceni4, Rakhi Maiwall5, Carlo Alessandria6, Javier Fernandez7, Dong Joon Kim8, Sung Eun Kim9, Elza Soares10, Monica Marino11, Julio Vorobioff12, Manuela Merli13, Laure Elkrief14, Victor Vargas15, Aleksander Krag16, Shivaram Singh17, Diego Giunta1, Martin Elizondo18, Maria Margarita Anders19..., Melisa Dirchwolf20, Manuel Mendizabal21, Cosmas Rinaldi Lesmana22, Claudio Toledo23, Florence Wong24, Francois Durand25, Adrian Gadano1, Paolo Angeli2Ver más

1 Liver unit and Department of research, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

2 Unit of Internal Medicine and Hepatology, University of Padova, Padova, Italia

3 Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

4 Institute of Liver and Biliary Sciences, University of Bologna, Bologna, Italia

5 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India

6 Division of Gastroenterology and Hepatology, Città della Salute e della Scienza Hospital, Turin, Italia

7 Liver ICU, Liver Unit, Hospital Clinic, Barcelona, España

8 Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Corea (del Sur)

9 Division of Gastroenterology and Hepatology, Department of Internal Medicin, Hallym Sacred Heart Hospital, Anyang City, Corea (del Sur)

10 Gastroenterology Division, Medicine Department, Faculty of Medical Sciences, University of Campinas (UNICAMP), San Pablo, Brasil

11 Liver Unit, Hospital Dr. Carlos B. Udaondo, Buenos Aires, Argentina

12 Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina

13 Gastroenterology and Hepatology Unit, Department of Clinical Medicine, Sapienza University of Rome, Roma, Italia

14 Service de Transplantation, Service d'Hépato-gastroentérologie, Hôpitaux Universitaires de Genève, Geneva, Suiza

15 Liver Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBERehd, Barcelona, España

16 Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Dinamarca

17 Department of Gastroenterology, S.C.B. Medical College, Cuttack, India

18 Liver Unit, Hospital Central de las Fuerzas Armadas y el Programa Nacional de Trasplante Hepático, Montevideo, Uruguay

19 Liver Unit, Hospital Aleman, Buenos Aires, Argentina

20 Liver Unit, Hospital Privado de Rosario, Rosario, Argentina

21 Liver Unit, Hospital Universitario Austral, Buenos Aires, Argentina

22 Digestive Disease and Oncology Centre, Medistra Hospital, Jakarta, Indonesia

23 Gastroenterology Unit, Hospital Valdivia, Valdivia, Chile

24 Division of Gastroenterology, Department of Medicine, University of Toronto, Ontario, Canadá

25 Hepatology & Liver Intensive Care, Hospital Beaujon, Clichy, Paris, Francia

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