Predictive score for patients with carbapenemase-producing enterobacterales colonization upon admission in a tertiary care hospital in an endemic area.

Autor:	Papafotiou C; First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece., Roussos S; Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece., Sypsa V; Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece., Bampali S; First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece., Spyridopoulou K; First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece., Karapanou A; First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece., Moussouli A; First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece., Samarkos M; First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece., Daikos GL; First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece., Psichogiou M; First Department of Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, 11527 Athens, Greece.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2022 Nov 28; Vol. 77 (12), pp. 3331-3339.
DOI:	10.1093/jac/dkac321
Abstrakt:	Objectives: Carbapenemase-producing Enterobacterales (CPE) comprise important nosocomial pathogens worldwide. Colonized patients are the source of further dissemination in healthcare settings. Considering that timely detection of CPE carriers is pivotal but universal screening is unfeasible, we aimed to develop and validate a prediction score to detect patients harbouring CPE on hospital admission. Methods: The study was conducted in a tertiary care hospital located in a CPE endemic area. Rectal swabs were obtained from 2303 patients, screened shortly after hospital admission. The Enterobacterales isolated in cultures were examined for the presence of blaVIM, KPC, NDM, OXA-48 by PCR. Demographic data and patient history of the previous 6 months were recorded. Risk factors for CPE carriage were identified using a multivariable logistic regression model and a points-system risk score was developed. The discriminative ability of the risk score was assessed using the AUC and its predictive performance was validated in a second dataset of 1391 patients in a different time period. Results: Seven predictors were identified: previous CPE colonization or infection, prior hospitalization, stay in a long-term health care facility, history of ≥2 interventions, renal replacement therapy, diabetes with end-organ damage and Karnofsky score. The developed risk score in the derivation dataset ranged between 0 and 79 points, with an AUC of 0.84 in the derivation and 0.85 in the validation dataset. Conclusions: This prediction tool may assist in identifying patients who are at risk of harbouring CPE on hospital admission in an endemic area and guide clinicians to implement prompt and appropriate infection control measures. (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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