Third-generation cephalosporin-resistant enterobacterial bacteraemia (3GCR-E-Bac) in hospital-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
1406
Version
1.6
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 hospital onset infection. 

    Study Population

    Total population size: 410

    Continuous characteristics

    Name LL Q1 Median Q3 UL Unit
    Age 55 64 73 years
    Length of hospital stay prior to infection 10 20 48 days

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Diabetes mellitus No 65
    Yes 16
    Any solid malignancy No 56
    Yes 25
    Haematological malignancy No 72
    Yes 9
    Renal disease No 67
    Yes 14
    Immunocompromised No 64
    Yes 16
    Any transplant No 66
    Yes 15
    Urological patient No 76
    Yes 5
    Surgical procedure (prior 30 days) No 45
    Yes 37
    Central vascular catheter (at infection onset) No 29
    Yes 46
    Signs of hypoperfusion (at infection onset) No 52
    Yes 25
    Suspected source of infection (at infection onset) Urinary tract infection 12
    Intra-abdominal infection 14
    Lower respiratory tract infection 4
    Other infection 11
    Unknown 39
    Prior identification of 3GCR-E (prior one year) No 53
    Yes 29
    Any use of antibiotics (prior 2 months) No 14
    Cephalosporins 49
    Fluoroquinolones 25
    Carbapenems 12
    At risk of 3GCR-E-Bac according to the two-predictor model No 17
    Yes 65
    Case/Control Cases 82
    Control 328

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

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    Result
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    The calculated risk for 3GCR-E-Bac in hospital-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 0.811 (95% CI: 0.742-0.873)

    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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