Third-generation cephalosporin-resistant enterobacterial bacteraemia (3GCR-E-Bac) in community-onset infection
The prediction score for 3GCR-E-Bac, specifically geared towards the initiation of empirical antibiotic treatment, may improve the balance between inappropriate antibiotics and carbapenem overuse.
Research authors: W.C. Rottier, C.H. van Werkhoven, Y.R.P. Bamberg, J.W. Dorigo-Zetsma, E.M. van de Garde, B.C. van Hees, J.A.J.W. Kluytmans, E.M. Kuck, P.D. van der Linden, J.M. Prins, S.F.T. Thijsen, A. Verbon, B.J.M. Vlaminckx, H.S.M. Ammerlaan, M.J.M. Bonten
Details Custom formula Study characteristics Files & References
★★★
Model author
Model ID
1405
Version
1.7
Revision date
2018-07-09
MeSH terms
  • Antibiotics
  • Enterobacteria
  • beta-Lactamases
  • Risk Factors
  • Model type
    Logistic regression (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    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

    The shown study characteristics concern the Cases in the group of patients with community onset infection. 

    Study Population

    Total population size: 450

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    Age 61 69 76 years

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Healthcare-associated infection No 40
    Yes 50
    Diabetes mellitus No 62
    Yes 28
    Any solid malignancy No 74
    Yes 16
    Haematological malignancy No 79
    Yes 11
    Renal disease No 77
    Yes 13
    Immunocompromised No 60
    Yes 27
    Any transplant No 76
    Yes 14
    Urological patient No 65
    Yes 25
    Surgical procedure (prior 30 days) No 86
    Yes 4
    Central vascular catheter (at infection onset) No 84
    Yes 5
    Signs of hypoperfusion (at infection onset) No 35
    Yes 55
    Suspected source of infection (at infection onset) Urinary tract infection 41
    Intra-abdominal infection 14
    Lower respiratory tract infection 8
    Other infection 5
    Unknown 22
    Prior identification of 3GCR-E (prior one year) No 68
    Yes 22
    Any use of antibiotics (prior 2 months) No 34
    Cephalosporins 14
    Fluoroquinolones 17
    Carbapenems 4
    At risk of 3GCR-E-Bac according to the two-predictor model No 40
    Yes 46
    Case/Controls Cases 90
    Controls 360

    The calculated risk for 3GCR-E-Bac in community-onset infection is:
    ...

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    Result
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    The calculated risk for 3GCR-E-Bac in community-onset infection is:

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    Outcome stratification

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    Conditional information

    Result interpretation

    The current prediction model showed adequate discriminatory power with a C-statistic of 0.775 (95% CI: 0.705-0.839)

    Before implementation of this prediction model, prospective external validation is required. The development of the prediction model relied on retrospective patient data available in medical charts. Pragmatic inclusion, and exclusion criteria were used which might not fully reflect intended clinical use. Moreover, potentially relevant predictors such as international travel, animal contact, known colonization in household members, dietary preferences, and colonization pressure in the ward were not collected 

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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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