Prediction of imipenem-resistant microorganisms among the nosocomial critically ill patients with Gram-negative bacilli septicemia: a simple risk score
| Autor: | Shih-Wen Ting, I-Ling Chen, Chen-Hsiang Lee, Lily Yu-Chin Wang |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Carbapenem Imipenem medicine.medical_treatment 030106 microbiology carbapenem 03 medical and health sciences Internal medicine medicine Pharmacology (medical) antimicrobial resistance bacteremia Original Research Pharmacology Mechanical ventilation Framingham Risk Score Receiver operating characteristic business.industry scoring system Odds ratio medicine.disease Infectious Diseases Infection and Drug Resistance nosocomial infection Bacteremia outcome business medicine.drug Kidney disease |
| Zdroj: | Infection and Drug Resistance |
| ISSN: | 1178-6973 |
| Popis: | I-Ling Chen,1,2 Chen-Hsiang Lee,2–4 Shih-Wen Ting,2,3 Lily Yu-Chin Wang1 1Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Infection Control Team, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 4College of Medicine, Chang Gung University, Kaohsiung, Taiwan Objectives: The increasing number of reports on infections due to carbapenem-resistant Gram-negative bacilli (GNB) has raised concerns, because they have complicated empiric or guided antibiotic therapy for critically ill patients. We aimed to develop a scoring system to predict nosocomial imipenem-resistant GNB (IR-GNB) septicemia among the critically ill patients.Materials and methods: The study included critically ill adult patients with nosocomial GNB septicemia at Kaohsiung Chang Gung Memorial Hospital (CGMH) in 2013–2015, and the scoring system for predicting IR-GNB septicemia was developed, followed by prospective validation conducted among patients at Linkou CGMH and Kaohsiung CGMH between January and June, 2016.Results: In the development of the scoring system, 748 patients were included. The independent factors associated with IR-GNB septicemia were prior exposure (days) to carbapenems (adjusted odds ratio [aOR] per 1-day increase, 1.1; 1–3 days: 2 points, 4–6 days: 5 points, 7–9 days: 8 points, and ≥10 days: 13 points), use of mechanical ventilation (aOR 3.7; 5 points), prior colonization with IR-GNB strains (aOR 3.5; 5 points) within 30 days before the onset of GNB septicemia, and comorbid condition with chronic kidney disease (aOR 2.1; 3 points). The internal validation showed an area under the receiver operating characteristic curve (ROC) of 0.75; and an external validation among 314 patients showed similarly good performance (ROC 0.77). Youden’s index indicated the score of ≥6 as the best cutoff value with sensitivity of 75% and specificity of 79%.Conclusion: This scoring system might help clinicians stratify the risk for developing IR-GNB septicemia among critically ill patients and combined antibiotics may be used until antimicrobial de-escalation/adjustment is clearly indicated by the subsequently identified GNB and its susceptibility profile. Keywords: antimicrobial resistance, carbapenem, bacteremia, nosocomial infection, scoring system, outcome |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|