Personalized medicine in hematologic malignancies: the ex-csepa model's role in Acinetobacter Baumannii bacteremia

Abstract

The Ex-CSEPA model was developed to predict 30-day mortality for patients with hematologic malignancies after a standard 14-day antibiotic (ATB) treatment for Acinetobacter baumannii bacteremia. This study systematically evaluated the model’s performance in stratifying patients into high-risk and low-risk categories and compared the efficacy of extended ATB therapy with the standard 14-day course. The Ex-CSEPA model integrates several critical factors: extended course ATB (Ex), clinical improvement (C), starting ATB time (S), ECOG score (E), Pitt’s bacteremia score (P), and APACHE II score (A) to comprehensively assess mortality risk. The findings demonstrated that the Ex-CSEPA model effectively distinguished between high-risk and low-risk patients, with significant differences in mortality risks. High-risk patients had lower median survival compared to low-risk patients (p-value < 0.001), confirming the model’s accuracy. While extended ATB therapy did not improve overall survival rates, high-risk individuals benefited significantly. Extended ATB therapy reduced mortality by 32% and increased survival time by 66%, according to multivariable and Weibull proportional-hazards regression analyses. This study emphasizes the advantage of extended therapy for high-risk individuals and the usefulness of the Ex-CSEPA model in directing personalized treatment. In conclusion, the Ex-CSEPA model is a robust tool with substantial clinical implications, supporting personalized interventions with extended ATB therapy for high-risk patients and validating the standard 14-day course for low-risk individuals.