RT Journal Article
T1 An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
A1 Deelen, J. W. Timoteus
A1 Rottier, Wouter C.
A1 Giron-Ortega, Jose A.
A1 Rodriguez-Bano, Jesus
A1 Harbarth, Stephan
A1 Tacconelli, Evelina
A1 Jacobsson, Gunnar
A1 Zahar, Jean-Ralph
A1 van-Werkhoven, Cornelis H.
A1 Bonten, Marc J. M.
K1 antibiotic resistance
K1 ESBL
K1 antibiotics
K1 bloodstream infection
K1 Bacteraemia
K1 Lactamase-producing enterobacteriaceae
K1 Hospital admission
K1 Bacteremia
K1 Patient
AB Background. The possibility of bloodstream infections caused by third-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 2 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 a comparator. Model discrimination and calibration were assessed. Impact on carbapenem use was assessed at several cutoff points.Results. 4650 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.79 (95% CI,.75-.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-GNIs (analysis 2) improved at similar percentages. 1683 HO infection episodes were included and the prevalence of 3GC-R-BSI was 4.9% (n = 83). Here model calibration was insufficient.Conclusions. A prediction rule for CO 3GC-R infection was validated in an international cohort and could improve empirical antibiotic use. Validation of the HO rule yielded suboptimal performance.
PB Oxford univ press inc
SN 1058-4838
YR 2020
FD 2020-07-09
LK https://hdl.handle.net/10668/27944
UL https://hdl.handle.net/10668/27944
LA en
NO Deelen JWT, Rottier WC, Giron Ortega JA, Rodriguez-Baño J, Harbarth S, Tacconelli E, et al. An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales. Clin Infect Dis. 2021 Dec 6;73(11):e4475-e4483.
DS RISalud
RD Apr 8, 2025