Development of diagnostic prediction tools for bacteraemia caused by third-generation cephalosporin-resistant enterobacteria in suspected bacterial infections: a nested case–control study
Autor: | B.J.M. Vlaminckx, E.M. van de Garde, C.H. van Werkhoven, B.C. van Hees, Wouter C. Rottier, P.D. van der Linden, Annelies Verbon, E.M. Kuck, Y.R.P. Bamberg, H.S.M. Ammerlaan, Jan M. Prins, J.W. Dorigo-Zetsma, Marc J. M. Bonten, Jan Kluytmans, Steven F. T. Thijsen |
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Přispěvatelé: | AII - Infectious diseases, Infectious diseases, Medical Microbiology & Infectious Diseases |
Jazyk: | angličtina |
Rok vydání: | 2018 |
Předmět: |
Male
0301 basic medicine Microbiology (medical) medicine.medical_specialty Carbapenem medicine.drug_class 030106 microbiology Antibiotics Cephalosporin Bacteremia Microbial Sensitivity Tests 03 medical and health sciences 0302 clinical medicine Enterobacteriaceae Risk Factors Internal medicine medicine Humans Community or 030212 general & internal medicine Aged Retrospective Studies Cross Infection Infection only business.industry Enterobacteriaceae Infections General Medicine Middle Aged Third generation Anti-Bacterial Agents Cephalosporins Infectious Diseases Case-Control Studies Nested case-control study Female business Clinical risk factor medicine.drug |
Zdroj: | Clinical microbiology and infection, 24(12), 1315-1321. Elsevier Limited Clinical Microbiology and Infection, 24(12), 1315-1321. Elsevier Ltd. |
ISSN: | 1198-743X |
Popis: | 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. |
Databáze: | OpenAIRE |
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