Journal article
An international prospective cohort study to validate two prediction rules for infections caused by 3rd-generation cephalosporin-resistant Enterobacterales.
- Deelen JWT Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
- Rottier WC Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
- Giron Ortega JA Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
- Rodriguez-Baño J Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.
- Harbarth S Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
- Tacconelli E Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy.
- Jacobsson G Region Västra Götaland, Skaraborg Hospital, Department of Infectious Diseases, Skövde, Sweden.
- Zahar JR IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention Du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Rue de Stalingrad, Bobigny, France.
- van Werkhoven CH Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
- Bonten MJM Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
- 2020-07-09
Published in:
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. - 2020
English
INTRODUCTION
The possibility of bloodstream infections caused by 3rd-generation cephalosporin-resistant Enterobacterales (3GC-R-BSI) leads to a trade-off between empiric inappropriate treatment (IAT) and unnecessary carbapenem use (UCU). Accurately predicting 3GC-R-BSI could reduce IAT and UCU. We externally validate two previously derived prediction rules for community-onset (CO) and hospital-onset (HO) suspected bloodstream infections.
METHODS
In 33 hospitals in 13 countries we prospectively enrolled 200 patients per hospital in whom blood cultures were obtained and intravenous antibiotics with coverage for Enterobacterales were empirically started. Cases were defined as 3GC-R-BSI or 3GC-R Gram-negative infection (3GC-R-GNI) (analysis 2), all other outcomes served as comparator. Model discrimination and calibration were assessed. Impact on carbapenem use was assessed at several cut-off points.
RESULTS
4,650 CO infection episodes were included and the prevalence of 3GC-R-BSI was 2.1% (n=97). IAT occurred in 69 of 97 (71.1%) 3GC-R-BSI and UCU in 398 of 4553 non-3GC-R-BSI patients (8.7%). Model calibration was good and the AUC was 0.79 (95% CI: 0.75 - 0.83) for 3GC-R-BSI. The prediction rule potentially reduced IAT to 62% (60/97) while keeping UCU comparable at 8.4% or could reduce UCU to 6.3% (287/4553) while keeping IAT equal. IAT and UCU in all 3GC-R-GNI (analysis 2) improved at similar percentages.1,683 HO infection episodes were included and the prevalence of 3GC-R-BSI was 4.9% (n=83). Here model calibration was insufficient.
CONCLUSION
A prediction rule for community-onset 3GC-R infection was validated in an international cohort and could improve empirical antibiotic use. Validation of the hospital-onset rule yielded suboptimal performance.
The possibility of bloodstream infections caused by 3rd-generation cephalosporin-resistant Enterobacterales (3GC-R-BSI) leads to a trade-off between empiric inappropriate treatment (IAT) and unnecessary carbapenem use (UCU). Accurately predicting 3GC-R-BSI could reduce IAT and UCU. We externally validate two previously derived prediction rules for community-onset (CO) and hospital-onset (HO) suspected bloodstream infections.
METHODS
In 33 hospitals in 13 countries we prospectively enrolled 200 patients per hospital in whom blood cultures were obtained and intravenous antibiotics with coverage for Enterobacterales were empirically started. Cases were defined as 3GC-R-BSI or 3GC-R Gram-negative infection (3GC-R-GNI) (analysis 2), all other outcomes served as comparator. Model discrimination and calibration were assessed. Impact on carbapenem use was assessed at several cut-off points.
RESULTS
4,650 CO infection episodes were included and the prevalence of 3GC-R-BSI was 2.1% (n=97). IAT occurred in 69 of 97 (71.1%) 3GC-R-BSI and UCU in 398 of 4553 non-3GC-R-BSI patients (8.7%). Model calibration was good and the AUC was 0.79 (95% CI: 0.75 - 0.83) for 3GC-R-BSI. The prediction rule potentially reduced IAT to 62% (60/97) while keeping UCU comparable at 8.4% or could reduce UCU to 6.3% (287/4553) while keeping IAT equal. IAT and UCU in all 3GC-R-GNI (analysis 2) improved at similar percentages.1,683 HO infection episodes were included and the prevalence of 3GC-R-BSI was 4.9% (n=83). Here model calibration was insufficient.
CONCLUSION
A prediction rule for community-onset 3GC-R infection was validated in an international cohort and could improve empirical antibiotic use. Validation of the hospital-onset rule yielded suboptimal performance.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
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- DOI 10.1093/cid/ciaa950
- PMID 32640024
- Persistent URL
- https://sonar.ch/global/documents/23328
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