Development of diagnostic prediction tools for bacteraemia caused by third-generation cephalosporin-resistant enterobacteria in suspected bacterial infections: a nested case-control study.

Autor:	Rottier WC; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands. Electronic address: w.c.rottier-2@umcutrecht.nl., van Werkhoven CH; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands., Bamberg YRP; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands., Dorigo-Zetsma JW; Central Laboratory for Bacteriology and Serology, Tergooi Hospitals, Hilversum, The Netherlands., van de Garde EM; Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands., van Hees BC; Department of Medical Microbiology and Infection Control, Gelre Hospitals, Apeldoorn, The Netherlands., Kluytmans JAJW; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands; Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands., Kuck EM; Department of Hospital Pharmacy, Diakonessenhuis, Utrecht, The Netherlands., van der Linden PD; Department of Clinical Pharmacy, Tergooi Hospitals, Hilversum, The Netherlands., Prins JM; Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands., Thijsen SFT; Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, The Netherlands., Verbon A; Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands., Vlaminckx BJM; Department of Medical Microbiology and Immunology, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands., Ammerlaan HSM; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands., Bonten MJM; Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Jazyk:	angličtina
Zdroj:	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2018 Dec; Vol. 24 (12), pp. 1315-1321. Date of Electronic Publication: 2018 Mar 23.
DOI:	10.1016/j.cmi.2018.03.023
Abstrakt:	Objectives: Current guidelines for the empirical antibiotic treatment predict the presence of third-generation cephalosporin-resistant enterobacterial bacteraemia (3GCR-E-Bac) in case of infection only poorly, thereby increasing unnecessary carbapenem use. We aimed to develop diagnostic scoring systems which can better predict the presence of 3GCR-E-Bac. Methods: A retrospective nested case-control study was performed that included patients ≥18 years of age from eight Dutch hospitals in whom blood cultures were obtained and intravenous antibiotics were initiated. Each patient with 3GCR-E-Bac was matched to four control infection episodes within the same hospital, based on blood-culture date and onset location (community or hospital). Starting from 32 commonly described clinical risk factors at infection onset, selection strategies were used to derive scoring systems for the probability of community- and hospital-onset 3GCR-E-Bac. Results: 3GCR-E-Bac occurred in 90 of 22 506 (0.4%) community-onset infections and in 82 of 8110 (1.0%) hospital-onset infections, and these cases were matched to 360 community-onset and 328 hospital-onset control episodes. The derived community-onset and hospital-onset scoring systems consisted of six and nine predictors, respectively. With selected score cut-offs, the models identified 3GCR-E-Bac with sensitivity equal to existing guidelines (community-onset: 54.3%; hospital-onset: 81.5%). However, they reduced the proportion of patients classified as at risk for 3GCR-E-Bac (i.e. eligible for empirical carbapenem therapy) with 40% (95%CI 21-56%) and 49% (95%CI 39-58%) in, respectively, community-onset and hospital-onset infections. Conclusions: These prediction scores for 3GCR-E-Bac, specifically geared towards the initiation of empirical antibiotic treatment, may improve the balance between inappropriate antibiotics and carbapenem overuse. (Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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