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Clinical Risk Score for Prediction of Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in Bloodstream Isolates

Published online by Cambridge University Press:  19 December 2016

Matthew R. Augustine ,
Traci L. Testerman ,
Julie Ann Justo ,
P. Brandon Bookstaver ,
Joseph Kohn ,
Helmut Albrecht  and
Majdi N. Al-Hasan
Matthew R. Augustine
Affiliation:
University of South Carolina School of Medicine, Columbia, South Carolina
Traci L. Testerman
Affiliation:
Department of Pathology, Microbiology, and Immunology, University of South Carolina School of Medicine, Columbia, South Carolina
Julie Ann Justo
Affiliation:
Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina
P. Brandon Bookstaver
Affiliation:
Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, South Carolina Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina
Joseph Kohn
Affiliation:
Department of Pharmacy, Palmetto Health Richland, Columbia, South Carolina
Helmut Albrecht
Affiliation:
University of South Carolina School of Medicine, Columbia, South Carolina Department of Medicine, Palmetto Health USC Medical Group, Columbia, South Carolina
Majdi N. Al-Hasan*
Affiliation:
University of South Carolina School of Medicine, Columbia, South Carolina Department of Medicine, Palmetto Health USC Medical Group, Columbia, South Carolina
*
Address correspondence to Majdi N. Al-Hasan, MBBS, Associate Professor of Medicine, University of South Carolina School of Medicine, 2 Medical Park, Suite 502, Columbia, SC 29203 (majdi.alhasan@uscmed.sc.edu).
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Abstract

OBJECTIVE

To develop a risk score to predict probability of bloodstream infections (BSIs) due to extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBLE).

DESIGN

Retrospective case-control study.

SETTING

Two large community hospitals.

PATIENTS

Hospitalized adults with Enterobacteriaceae BSI between January 1, 2010, and June 30, 2015.

METHODS

Multivariate logistic regression was used to identify independent risk factors for ESBLE BSI. Point allocation in extended-spectrum β-lactamase prediction score (ESBL-PS) was based on regression coefficients.

RESULTS

Among 910 patients with Enterobacteriaceae BSI, 42 (4.6%) had ESBLE bloodstream isolates. Most ESBLE BSIs were community onset (33 of 42; 79%), and 25 (60%) were due to Escherichia coli. Independent risk factors for ESBLE BSI and point allocation in ESBL-PS included outpatient procedures within 1 month (adjusted odds ratio [aOR], 8.7; 95% confidence interval [CI], 3.1–22.9; 1 point), prior infections or colonization with ESBLE within 12 months (aOR, 26.8; 95% CI, 7.0–108.2; 4 points), and number of prior courses of β-lactams and/or fluoroquinolones used within 3 months of BSI: 1 course (aOR, 6.3; 95% CI, 2.7–14.7; 1 point), ≥2 courses (aOR, 22.0; 95% CI, 8.6–57.1; 3 points). The area under the receiver operating characteristic curve for the ESBL-PS model was 0.86. Patients with ESBL-PSs of 0, 1, 3, and 4 had estimated probabilities of ESBLE BSI of 0.7%, 5%, 24%, and 44%, respectively. Using ESBL-PS ≥3 to indicate high risk provided a negative predictive value of 97%.

CONCLUSIONS

ESBL-PS estimated patient-specific risk of ESBLE BSI with high discrimination. Incorporation of ESBL-PS with acute severity of illness may improve adequacy of empirical antimicrobial therapy and reduce carbapenem utilization.

Infect Control Hosp Epidemiol 2017;38:266–272

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 266 - 272
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: The preliminary results of this study were presented in part at the American Society for Microbiology Microbe conference on June 20, 2016, in Boston, Massachusetts (Abstract no. MO-127).

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