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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
Formula
Study characteristics
Files & References
★★★
Model author
Model ID
1405
Version
1.7
Revision date
2018-07-09
Specialty
MeSH terms
Model type
Logistic regression
(Calculation)
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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-BacThe shown study characteristics concern the Cases in the group of patients with community onset infection.
Study Population
Total population size: 450Continuous 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 |
Related files
No related files available
Supporting Publications
| Title or description | Tags |
|---|---|
| Development of diagnostic prediction tools for bacteraemia caused by third-generation cephalosporin-resistant enterobacteria in suspected bacterial infections: a nested case-control study. | Internal validation Paper Peer review |
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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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
Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.
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