title: Clinical risk scoring system for predicting extended-spectrum β-lactamase-producing Escherichia coli infection in hospitalized patients.
abstract: BACKGROUND
  Extended spectrum β-lactamase-producing Escherichia coli (ESBL-EC) has important implications for infection control and empiric antibiotic prescribing. This study aims to develop a risk scoring system for predicting ESBL-EC infection based on local epidemiology.
  
  
  METHODS
  The study retrospectively collected eligible patients with a positive culture for E. coli during 2011 to 2014. The risk scoring system was developed using variables independently associated with ESBL-EC infection through logistic regression-based prediction. Area under the receiver-operator characteristic curve (AuROC) was determined to confirm the prediction power of the model.
  
  
  RESULTS
  Predictors for ESBL-EC infection were male gender [odds ratio (OR): 1.53], age ≥55 years (OR: 1.50), healthcare-associated infection (OR: 3.21), hospital-acquired infection (OR: 2.28), sepsis (OR: 1.79), prolonged hospitalization (OR: 1.88), history of ESBL infection within one year (OR: 7.88), prior use of broad-spectrum cephalosporins within three months (OR: 12.92), and prior use of other antibiotics within three months (OR: 2.14). Points scored ranged from 0 to 47, and were divided into three groups based on diagnostic performance parameters: low risk (score: 0-8; 44.57%), moderate risk (score: 9-11; 21.85%) and high risk (score: ≥12; 33.58%). The model displayed moderate power of prediction (AuROC: 0.773; 95% confidence interval: 0.742-0.805) and good calibration (Hosmer-Lemeshow χ(2) = 13.29; P = 0.065).
  
  
  CONCLUSIONS
  This tool may optimize the prescribing of empirical antibiotic therapy, minimize time to identify patients, and prevent spreading of ESBL-EC. Prior to adoption into routine clinical practice, further validation study of the tool is needed.
authors.affiliation: School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
authors.forename: K
authors.initials: K
authors.lastname: Kengkla
authors.affiliation: School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
authors.forename: N
authors.initials: N
authors.lastname: Charoensuk
authors.affiliation: School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
authors.forename: M
authors.initials: M
authors.lastname: Chaichana
authors.affiliation: School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Puangjan
authors.affiliation: School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
authors.forename: T
authors.initials: T
authors.lastname: Rattanapornsompong
authors.affiliation: School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
authors.forename: J
authors.initials: J
authors.lastname: Choorassamee
authors.affiliation: School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand.
authors.forename: P
authors.initials: P
authors.lastname: Wilairat
authors.affiliation: School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand. Electronic address: saokaew@gmail.com.
authors.forename: S
authors.initials: S
authors.lastname: Saokaew
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003661:Decision Support Techniques; D004926:Escherichia coli / Q000201:enzymology*; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: Clinical prediction rule; Escherichia coli; Extended-spectrum β-lactamase; Risk scoring system