RT Journal Article
SR Electronic
T1 Diagnostic prediction tools for bacteraemia caused by 3rd generation cephalosporin-resistant Enterobacteriaceae in suspected bacterial infections: a nested case-control study
JF bioRxiv
FD Cold Spring Harbor Laboratory
SP 120550
DO 10.1101/120550
A1 Wouter C. Rottier
A1 Cornelis H. van Werkhoven
A1 Yara R. P. Bamberg
A1 J. Wendelien Dorigo-Zetsma
A1 Ewoudt M. van de Garde
A1 Babette C. van Hees
A1 Jan A. J. W. Kluytmans
A1 Emile M Kuck
A1 Paul D. van der Linden
A1 Jan M. Prins
A1 Steven F. T. Thijsen
A1 Annelies Verbon
A1 Bart J. M. Vlaminckx
A1 Heidi S M Ammerlaan
A1 Marc J. M. Bonten
YR 2017
UL http://biorxiv.org/content/early/2017/04/10/120550.abstract
AB Objectives Current antibiotic treatment guidelines on when to consider 3rd generation cephalosporin resistant Enterobacteriaceae (3GC-R EB) as a cause of infection have low specificity, thereby increasing unnecessary carbapenem use. Therefore, we aimed to develop new diagnostic scoring systems to direct initial carbapenem treatment to patients at risk of 3GC-R EB bacteraemia.Methods A retrospective nested case-control study was performed that included patients ≥18 years from 8 Dutch hospitals in whom blood cultures were obtained and intravenous antibiotics were initiated. Patients with 3GC-R EB bacteraemia were each 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 available at infection onset, selection strategies were used to derive scoring systems for the probability of community‐ and hospital-onset 3GC-R EB bacteraemia.Results Among 22,506 community-onset and 8,110 hospital-onset infections, respectively 90 (0.4%) and 82 (1.0%) were 3GC-R EB bacteraemias. As control populations, 360 community-onset and 328 hospital-onset infection episodes were included. The derived community-onset and hospital-onset scoring system consisted of 6 and 9 predictors, respectively, and both showed good discrimination with c-statistics of 0.807 and 0.842. Cutoffs for the scores could be chosen such that ~20% of patients would be eligible for empirical carbapenem treatment, which would capture ~70% of those with 3GC-R EB bacteraemia.Conclusions These prediction rules for 3GC-R EB bacteraemia, specifically geared towards the initiation of empiric antibiotic treatment, may improve the balance between inappropriate antibiotics and carbapenem overuse.