title: Clinical Risk Score for Prediction of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Bloodstream Isolates.
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.
authors.affiliation: 1University of South Carolina School of Medicine,Columbia,South Carolina.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Augustine
authors.affiliation: 2Department of Pathology, Microbiology, and Immunology,University of South Carolina School of Medicine,Columbia,South Carolina.
authors.forename: Traci L
authors.initials: TL
authors.lastname: Testerman
authors.affiliation: 3Department of Clinical Pharmacy and Outcomes Sciences,South Carolina College of Pharmacy,University of South Carolina,Columbia,South Carolina.
authors.forename: Julie Ann
authors.initials: JA
authors.lastname: Justo
authors.affiliation: 3Department of Clinical Pharmacy and Outcomes Sciences,South Carolina College of Pharmacy,University of South Carolina,Columbia,South Carolina.
authors.forename: P Brandon
authors.initials: PB
authors.lastname: Bookstaver
authors.affiliation: 4Department of Pharmacy,Palmetto Health Richland,Columbia,South Carolina.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kohn
authors.affiliation: 1University of South Carolina School of Medicine,Columbia,South Carolina.
authors.forename: Helmut
authors.initials: H
authors.lastname: Albrecht
authors.affiliation: 1University of South Carolina School of Medicine,Columbia,South Carolina.
authors.forename: Majdi N
authors.initials: MN
authors.lastname: Al-Hasan
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology; D016022:Case-Control Studies; D004755:Enterobacteriaceae / Q000201:enzymology / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000188:drug therapy*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013022:South Carolina; D001618:beta-Lactamases / Q000096:biosynthesis; D047090:beta-Lactams / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D047090:beta-Lactams; D001618:beta-Lactamases