A simple scoring algorithm predicting extendedspectrum b-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia

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Abstract

The incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBLproducer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB). In a retrospective cohort,multicenter study, adults with CoMEBin theemergency department (ED)were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype.Clinical information was obtained fromchart records. Of the total 1141 adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs) - recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98) - were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6%) and an acceptable specificity (92.5%); the area under the receiver operating characteristic curve was 0.92. In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

Original languageEnglish
Article numbere6648
JournalMedicine (United States)
Volume96
Issue number16
DOIs
Publication statusPublished - 2017 Jan 1

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Enterobacteriaceae
Bacteremia
Odds Ratio
Infection
Nursing Homes
ROC Curve
Multicenter Studies
Cohort Studies
Phenotype
Incidence
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

@article{1c9b39c0c9b043988840f90fef4d33a3,
title = "A simple scoring algorithm predicting extendedspectrum b-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia",
abstract = "The incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBLproducer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB). In a retrospective cohort,multicenter study, adults with CoMEBin theemergency department (ED)were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype.Clinical information was obtained fromchart records. Of the total 1141 adults with CoMEB, 65 (5.7{\%}) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs) - recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98) - were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6{\%}) and an acceptable specificity (92.5{\%}); the area under the receiver operating characteristic curve was 0.92. In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.",
author = "Chung-Hsun Lee and Chu, {Feng Yuan} and Chih-Chia Hsieh and Ming-Yuan Hong and Chih-Hsien Chi and Wen-Chien Ko and Lee, {Ching Chi}",
year = "2017",
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language = "English",
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journal = "Medicine (United States)",
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T1 - A simple scoring algorithm predicting extendedspectrum b-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia

AU - Lee, Chung-Hsun

AU - Chu, Feng Yuan

AU - Hsieh, Chih-Chia

AU - Hong, Ming-Yuan

AU - Chi, Chih-Hsien

AU - Ko, Wen-Chien

AU - Lee, Ching Chi

PY - 2017/1/1

Y1 - 2017/1/1

N2 - The incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBLproducer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB). In a retrospective cohort,multicenter study, adults with CoMEBin theemergency department (ED)were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype.Clinical information was obtained fromchart records. Of the total 1141 adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs) - recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98) - were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6%) and an acceptable specificity (92.5%); the area under the receiver operating characteristic curve was 0.92. In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

AB - The incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBLproducer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB). In a retrospective cohort,multicenter study, adults with CoMEBin theemergency department (ED)were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype.Clinical information was obtained fromchart records. Of the total 1141 adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs) - recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98) - were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6%) and an acceptable specificity (92.5%); the area under the receiver operating characteristic curve was 0.92. In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

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