Skip to main content Accessibility help
×
×
Home

Utility of a Clinical Risk Factor Scoring Model in Predicting Infection with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae on Hospital Admission

  • Steven W. Johnson (a1) (a2), Deverick J. Anderson (a1), D. Byron May (a1) (a2) and Richard H. Drew (a1) (a2)

Abstract

Objective.

To validate the utility of a previously published scoring model (Italian) to identify patients infected with community-onset extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-EKP) and develop a new model (Duke) based on local epidemiology.

Methods.

This case-control study included patients 18 years of age or more admitted to Duke University Hospital between January 1, 2008, and December 31, 2010, with culture-confirmed infection due to an ESBL-EKP (cases). Uninfected controls were matched to cases (3 : 1). The Italian model was applied to our patient population for validation. The Duke model was developed through logistic-regression-based prediction scores calculated on variables independently associated with ESBL-EKP isolation. Sensitivities and specificities at various point cutoffs were determined, and determination of the area under the receiver operating characteristic curve (ROC AUC) was performed.

Results.

A total of 123 cases and 375 controls were identified. Adjusted odds ratios and 95% confidence intervals for variables previously identified in the Italian model were as follows: hospitalization (3.20 [1.62–6.55]), transfer (4.31 [2.15–8.78]), urinary catheterization (5.92 [3.09–11.60]), β-lactam and/or fluoroquinolone therapy (3.76 [2.06–6.95]), age 70 years or more (1.55 [0.79–3.01]), and Charlson Comorbidity Score of 4 or above (1.06 [0.55–2.01]). Sensitivity and specificity were, respectively, more than or equal to 95% and less than or equal to 47% for scores 3 or below and were less than or equal to 50% and more than or equal to 96% for scores 8 or above. The ROC AUC was 0.88. Variables identified in the Duke model were as follows: hospitalization (2.63 [1.32–5.41]), transfer (5.30 [2.67–10.71]), urinary catheterization (6.89 [3.62–13.38]), β-lactam and/or fluoroquinolone therapy (3.47 [1.91–6.41]), and immunosuppression (2.34 [1.14–4.80]). Sensitivity and specificity were, respectively, more than or equal to 94% and less than or equal to 65% for scores 3 or below and were less than or equal to 58% and more than or equal to 95% for scores 8 or above. The ROC AUC was 0.89.

Conclusion.

While the previously reported model was an excellent predictor of community-onset ESBL-EKP infection, models utilizing factors based on local epidemiology may be associated with improved performance.

Copyright

Corresponding author

Campbell University College of Pharmacy, and Health Sciences, 1612 Barndale Glen Court, Winston-Salem, NC 27106 (johnsonsw@campbell.edu)

References

Hide All
1.Aloush, V, Navon-Venezia, S, Seigman-Igra, Y, Cabili, S, Carmeli, Y. Multidrug-resistant Pseudomonas aeruginosa: risk factors and clinical impact. Antimicrob Agents Chemother 2006;50(1):4348.
2.Furuno, JP, Harris, AD, Wright, MO, et al.Prediction rules to identify patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci upon hospital admission. Am J Infect Control 2004;32(8):436440.
3.Giske, CG, Monnet, DL, Cars, O, Carmeli, Y. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 2008;52(3):813821.
4.Harris, AD, McGregor, JC, Johnson, JA, et al.Risk factors for colonization with extended-spectrum β-lactamase–producing bacteria and intensive care unit admission. Emerg Infect Dis 2007;13(8):11441149.
5.Tumbarello, M, Trecarichi, EM, Bassetti, M, et al.Identifying patients harboring extended-spectrum-β-lactamase-producing Enterobacteriaceae on hospital admission: derivation and validation of a scoring system. Antimicrob Agents Chemother 2011;55(7):34853490.
6.Wright, SW, Wrenn, KD, Haynes, M, Haas, DW. Prevalence and risk factors for multidrug resistant uropathogens in ED patients. Am J Emerg Med 2000;18(2):143146.
7.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(suppl 2):S82S89.
8.Kim, BN, Woo, JH, Kim, MN, Ryu, J, Kim, YS. Clinical implications of extended-spectrum β-lactamase-producing Klebsiella pneumoniae bacteraemia. J Hosp Infect 2002;52(2):99106.
9.Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum β-lactamase–producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32(8):11621171.
10.Melzer, M, Petersen, I. Mortality following bacteraemic infection caused by extended spectrum beta-lactamase (ESBL) producing E. coli compared to non-ESBL producing E. coli. J Infect 2007;55(3):254259.
11.Peralta, G, Sanchez, MB, Garrido, JC, et al.Impact of antibiotic resistance and of adequate empirical antibiotic treatment in the prognosis of patients with Escherichia coli bacteraemia. J Antimicrob Chemother 2007;60(4):855863.
12.Schwaber, MJ, Navon-Venezia, S, Kaye, KS, Ben-Ami, R, Schwartz, D, Carmeli, Y. Clinical and economic impact of bacteremia with extended-spectrum-β-lactamase-producing Enterobacteriaceae. Antimicrob Agents Chemother 2006;50(4):12571262.
13.Schwaber, MJ, Carmeli, Y. Mortality and delay in effective therapy associated with extended-spectrum β-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 2007;60(5):913920.
14.Tumbarello, M, Sanguinetti, M, Montuori, E, et al.Predictors of mortality in patients with bloodstream infections caused by extended-spectrum-β-lactamase-producing Enterobacteriaceae: importance of inadequate initial antimicrobial treatment. Antimicrob Agents Chemother 2007;51(6):19871994.
15.Harbarth, S, Sax, H, Fankhauser-Rodriguez, C, Schrenzel, J, Agostinho, A, Pittet, D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med 2006;119(3):275.e15–275.e23.
16.Clinical and Laboratory Standards Institute (CLSI). 2009. Performance Standards for Antimicrobial Susceptibility Testing: 19th Informational Supplement. Wayne, PA: CLSI, 2012. CLSI document M100-S19.
17.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373383.
18.Fawcett, T. An introduction to ROC analysis. Pattern Recognit Lett 2006;27:861874.
19.Sullivan, LM, Massaro, JM, D'Agostino, RB Sr.Presentation of multivariate data for clinical use: the Framingham study risk score functions. Stat Med 2004;23(10):16311660.
20.Apisarnthanarak, A, Kiratisin, P, Saifon, P, Kitphati, R, Dejsirilert, S, Mundy, LM. Predictors of mortality among patients with community-onset infection due to extended-spectrum β-lactamase–producing Escherichia coli in Thailand. Infect Control Hosp Epidemiol 2008;29(1):8082.
21.Azap, OK, Arslan, H, Serefhanoglu, K, et al.Risk factors for extended-spectrum β-lactamase positivity in uropathogenic Escherichia coli isolated from community-acquired urinary tract infections. Clin Microbiol Infect 2010;16(2):147151.
22.Coque, TM, Baquero, F, Canton, R. Increasing prevalence of ESBL-producing Enterobacteriaceae in Europe. Euro Surveill 2008;13(47):pii= 19044.
23.Hawser, SP, Bouchillon, SK, Hoban, DJ, Badal, RE, Canton, R, Baquero, F. Incidence and antimicrobial susceptibility of Escherichia coli and Klebsiella pneumoniae with extended-spectrum β-lactamases in community- and hospital-associated intra-abdominal infections in Europe: results of the 2008 Study for Monitoring Antimicrobial Resistance Trends (SMART). Antimicrob Agents Chemother 2010;54(7):30433046.
24.Laupacis, A, Sekar, N, Stiell, IG. Clinical prediction rules: a review and suggested modifications of methodological standards. JAMA 1997;277(6):488494.
25.Tacconelli, E, Karchmer, AW, Yokoe, D, D'Agata, EM. Preventing the influx of vancomycin-resistant enterococci into health care institutions, by use of a simple validated prediction rule. Clin Infect Dis 2004;39(7):964970.
26.Tacconelli, E, Cataldo, MA, De, AG, Cauda, R. Risk scoring and bloodstream infections. Int J Antimicrob Agents 2007;30(suppl 1):S88S92.
27.Aliberti, S, Di, PM, Zanaboni, AM, et al.Stratifying risk factors for multidrug-resistant pathogens in hospitalized patients coming from the community with pneumonia. Clin Infect Dis 2012;54(4):470478.
28.Calbo, E, Romani, V, Xercavins, M, et al.Risk factors for community-onset urinary tract infections due to Escherichia coli harbouring extended-spectrum β-lactamases. J Antimicrob Chemother 2006;57(4):780783.
29.Demirdag, K, Hosoglu, S. Epidemiology and risk factors for ESBL-producing Klebsiella pneumoniae: a case control study. J Infect Dev Ctries 2010;4(11):717722.
30.Graffunder, EM, Preston, KE, Evans, AM, Venezia, RA. Risk factors associated with extended-spectrum β-lactamase-producing organisms at a tertiary care hospital. J Antimicrob Chemother 2005;56(1):139145.
31.van, GJ, Florence, E, Van den Ende, J. Validation of clinical scores for risk assessment. Clin Infect Dis 2012;54(10):15201521.
32.Zweig, MH, Campbell, G. Receiver-operating characteristic (ROC) plots: a fundamental evaluation tool in clinical medicine. Clin Chem 1993;39(4):561577.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed