Evaluation of the Gianella Risk Score in adult patients with rectal colonization by carbapenemase-producing klebsiella pneumoniae at the Hospital General del Norte de Guayaquil Los Ceibos, during the period from January 2018 to June 2019.

Abstract

Introduction: In 2014, Gianella et al. created the Gianella Risk score (GRS) which is able to predict bloodstream infection (BSI) due to Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae (Kpc-Kp) in patients with Kp-Kpc rectal colonization. KPC infection have a mortality of 41%, for this reason the objective of this study is to evaluate the predictive certainty of the GRS in patients with Kpc-Kp rectal colonization.

Materials and method: A cases and controls, observational, retrospective, cross-sectional and analytical study was carried out with information from medical records of patients treated at the “Hospital General del Norte de Guayaquil Los Ceibos” from January 2018 to June 2019. 

Results: Kp-Kpc bloodstream infection had an incidence rate of 5.63% (95% CI: 3.07-9.44) and prevalence of 14.43%. ROC curve reveal: optimal cut-off points GRS≥7, AUC 0.778 (95% CI: 0.64 -0.91; p-value 0,001), sensitivity 71.4%, specificity 77.1%, PPV 34.5%, NPV 94.1%, LR + 3.11 and LR- 0.371. To Have a GRS≥7 turned out to be an independent risk factor for Kp-Kpc BSI development (OR: 7.20; 95% CI: 2.00-25.90; p value <0.001). Fatality rate due to bacteremia was 50% in those with a GRS <7 and in patients with GRS≥7 was 60%.

Conclusions: Despite the low prevalence and incidence rate of Kp-Kpc BSI, with the cutoff point ≥7, the higher risk of BSI above this cutoff point and the high letality rate in those with GRS≥7, the predictive efficacy of the GRS for BSI due to Kpc-Kp in patients with Kp-Kpc rectal colonization is shown to be valid.