A simple scoring algorithm predicting extended-spectrum β-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia

Abstract

The incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBL-producer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB).In a retrospective cohort, multicenter study, adults with CoMEB in the emergency department (ED) were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype. Clinical information was obtained from chart records.Of the total 1141 adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs)—recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98)—were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6%) and an acceptable specificity (92.5%); the area under the receiver operating characteristic curve was 0.92.In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

Risk Factors and Outcomes for Ineffective Empiric Treatment of Sepsis Caused by Gram-Negative Pathogens: Stratification by Onset of Infection

“…Our findings confirm the importance of prior intravenous antibiotic exposure as a risk factor for infection with antibiotic-resistant bacteria promoting IET (6,9). We also demonstrated that the risk factors and outcomes for IET differ according to the onset of infection.…”

Minimizing Time to Optimal Antimicrobial Therapy for Enterobacteriaceae Bloodstream Infections: A Retrospective, Hypothetical Application of Predictive Scoring Tools vs Rapid Diagnostics Tests

“…This scoring tool created weight-based scores based on magnitude of risk with each factor, and after analysis of various scores, the authors recommended that patients with high risk of an ESBL BSI (prediction score of ≥3) or critically ill moderate-risk patients (score of 1–2) should receive an empiric carbapenem. This cutoff threshold of 3 demonstrated a negative predictive value (NPV) of 97%, and thus there was confidence that it would not lead to undertreatment in many patients [ 7 ].…”

Blood Cultures and Broad-Spectrum Antimicrobials are Essential for Patients with Out-of-Hospital Cardiac Arrest

“…Of AROs in the community, ESBL-producers have well known adverse effects on the prognoses of bacteremic patients in the literature [35]. Clinical predictors of ESBL-producers in community-onset bacteremia, including healthcare facility residents, urinary catheter use, previous antimicrobial therapy, frequent ED visits [36], and previous hospitalization have been reported [35]. Because of the retrospective nature of the present study, some variables were di cult to assess.…”