title: Value of American Thoracic Society guidelines in predicting infection or colonization with multidrug-resistant organisms in critically ill patients.
abstract: BACKGROUND
  The incidence rate of infection by multidrug-resistant organisms (MDROs) can affect the accuracy of etiological diagnosis when using American Thoracic Society (ATS) guidelines. We determined the accuracy of the ATS guidelines in predicting infection or colonization by MDROs over 18 months at a single ICU in eastern China.
  
  
  METHODS
  This prospective observational study examined consecutive patients who were admitted to an intensive care unit (ICU) in Nanjing, China. MDROs were defined as bacteria that were resistant to at least three antimicrobial classes, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Pseudomonas aeruginosa, Acinetobacter baumannii. Screening for MDROs was performed at ICU admission and discharge. Risk factors for infection or colonization with MDROs were recorded, and the accuracy of the ATS guidelines in predicting infection or colonization with MDROs was documented.
  
  
  RESULTS
  There were 610 patients, 225 (37%) of whom were colonized or infected with MDROs at ICU admission, and this increased to 311 (51%) at discharge. At admission, the sensitivity (70.0%), specificity (31.6%), positive predictive value (38.2%), and negative predictive value (63.5%), all based on ATS guidelines for infection or colonization with MDROs were low. The negative predictive value was greater in patients from departments with MDRO infection rates of 31-40% than in patients from departments with MDRO infection rates of 30% or less and from departments with MDRO infection rates more than 40%.
  
  
  CONCLUSIONS
  ATS criteria were not reliable in predicting infection or colonization with MDROs in our ICU. The negative predictive value was greater in patients from departments with intermediate rates of MDRO infection than in patients from departments with low or high rates of MDRO infection.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01667991.
authors.affiliation: Department of Critical Care Medicine, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, China.
authors.forename: Jianfeng
authors.initials: J
authors.lastname: Xie
authors.affiliation: School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Xudong
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Critical Care Medicine, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, China.
authors.forename: Yingzi
authors.initials: Y
authors.lastname: Huang
authors.affiliation: Department of Critical Care Medicine, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, China.
authors.forename: Min
authors.initials: M
authors.lastname: Mo
authors.affiliation: Department of Critical Care Medicine, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, China.
authors.forename: Fengmei
authors.initials: F
authors.lastname: Guo
authors.affiliation: Department of Critical Care Medicine, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Department of Critical Care Medicine, Zhong-Da Hospital, School of Medicine, Southeast University, Nanjing, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Qiu
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects / Q000254:growth & development* / Q000472:pathogenicity; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002681:China; D016638:Critical Illness; D024901:Drug Resistance, Multiple, Bacterial; D016983:Enterococcus / Q000187:drug effects / Q000254:growth & development* / Q000472:pathogenicity; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000254:growth & development* / Q000472:pathogenicity; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000254:growth & development* / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents