Predictive Score for Carbapenem-Resistant Gram-Negative Bacilli Sepsis: Single-Center Prospective Cohort Study.

Autor:	Gomes MZR; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil.; Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil.; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil.; Hospital Infection Control Committee, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil., Braga DQ; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil.; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Pinheiro DOBP; Hospital Infection Control Committee, Hospital Universitário Pedro Ernesto, Rio de Janeiro State University, Rio de Janeiro 20551-030, Brazil., Verduc RCAS; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil.; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Dos Reis LV; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., de Lima EM; Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil.; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Lourenço ND; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Cid PA; Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Beck DS; Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Pinheiro LHZ; Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Tonhá JPS; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., de Sousa LS; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Dias MLS; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., da Silva Machado AA; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Castro MM; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Dutra VPR; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., de Mello LS; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., da Silva MC; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Tozo TM; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Mathuiy YR; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., de Abreu Rosas LLP; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Barros PCM; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., da Silva JO; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., da Silva PP; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., Bandeira CS; Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Oswaldo Cruz Foundation (IOC/FIOCRUZ), Rio de Janeiro 21040-900, Brazil., de Sant Anna Reis Di Chiara Salgado SM; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., de Oliveira Alves MZ; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Santos RQ; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Marques JA; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Rodrigues CAS; Hospital Federal dos Servidores do Estado (HFSE), Ministry of Health, Rio de Janeiro 20221-903, Brazil., Dos Santos Gomes Junior SC; Instituto Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro 22250-020, Brazil.
Jazyk:	angličtina
Zdroj:	Antibiotics (Basel, Switzerland) [Antibiotics (Basel)] 2022 Dec 23; Vol. 12 (1). Date of Electronic Publication: 2022 Dec 23.
DOI:	10.3390/antibiotics12010021
Abstrakt:	A clinical-epidemiological score to predict CR-GNB sepsis to guide empirical antimicrobial therapy (EAT), using local data, persists as an unmet need. On the basis of a case-case-control design in a prospective cohort study, the predictive factors for CR-GNB sepsis were previously determined as prior infection, use of mechanical ventilation and carbapenem, and length of hospital stay. In this study, each factor was scored according to the logistic regression coefficients, and the ROC curve analysis determined its accuracy in predicting CR-GNB sepsis in the entire cohort. Among the total of 629 admissions followed by 7797 patient-days, 329 single or recurrent episodes of SIRS/sepsis were enrolled, from August 2015 to March 2017. At least one species of CR-GNB was identified as the etiology in 108 (33%) episodes, and 221 were classified as the control group. The cutoff point of ≥3 (maximum of 4) had the best sensitivity/specificity, while ≤1 showed excellent sensitivity to exclude CR-GNB sepsis. The area under the curve was 0.80 (95% CI: 0.76-0.85) and the number needed to treat was 2.0. The score may improve CR-GNB coverage and spare polymyxins with 22% (95% CI: 17-28%) adequacy rate change. The score has a good ability to predict CR-GNB sepsis and to guide EAT in the future.
Databáze:	MEDLINE
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