Demographic and infection characteristics of patients with carbapenem-resistant Enterobacteriaceae in a community hospital: Development of a bedside clinical score for risk assessment.
BACKGROUND
The objective of this study was to identify risk factors associated with the presence of carbapenem-resistant Enterobacteriaceae (CRE) infections to develop a clinical prediction model that can be used at patient bedside to identify subjects likely infected with a CRE pathogen.


METHODS
This case-control study included patients aged ≥18 years admitted to Novant Health Forsyth Medical Center between January 1, 2012, and December 31, 2013, with CRE infections (cases) or non-CRE infections (controls). Controls were matched to their corresponding resistant case (3:1) based on pathogen, place of likely acquisition, isolate source, year of admission, and level of care. A risk prediction model was developed using variables independently associated with CRE isolation. Sensitivities and specificities were obtained at various point cutoffs, and a determination of the receiver operator characteristic (ROC) area under the curve (AUC) was performed.


RESULTS
A total of 164 subjects were included. Independent risk factors for CRE included recent antibiotic therapy, recent immunosuppression, and Charlson Comorbidity Index score ≥4. Adjusted odds ratios were 13.37 (95% confidence interval [CI], 4.16-61.19), 6.69 (95% CI, 1.85-29.65), and 3.30 (95% CI, 1.34-8.40), respectively. Diagnostic performance of various score cutoffs for the model indicated a score ≥5 correlated with the highest accuracy (79%). The ROC AUC was 0.83.


CONCLUSIONS
The risk prediction model displayed good discrimination and was an excellent predictor of CRE infection.
Novant Health Forsyth Medical Center, Winston-Salem, NC.
Brooke M
BM
Miller
Novant Health Forsyth Medical Center, Winston-Salem, NC; Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC. Electronic address: johnsonsw@campbell.edu.
Steven W
SW
Johnson
D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D015780:Carbapenems / Q000494:pharmacology*; D016022:Case-Control Studies; D003710:Demography; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018440:beta-Lactam Resistance
D015780:Carbapenems
CRE; Carbapenem-resistant Enterobacteriaceae; Enterobacteriaceae; Prediction model; Risk factors