Predicting probability of perirectal colonization with carbapenem-resistant Enterobacteriaceae (CRE) and other carbapenem-resistant organisms (CROs) at hospital unit admission.
Adult
Aged
Baltimore
/ epidemiology
Carbapenem-Resistant Enterobacteriaceae
/ isolation & purification
Carbapenems
Carrier State
/ microbiology
Cohort Studies
Decision Trees
Drug Resistance, Multiple, Bacterial
Enterobacteriaceae Infections
/ diagnosis
Female
Hospitals, University
Humans
Machine Learning
Male
Middle Aged
Patient Admission
Rectum
/ microbiology
Sensitivity and Specificity
Young Adult
Journal
Infection control and hospital epidemiology
ISSN: 1559-6834
Titre abrégé: Infect Control Hosp Epidemiol
Pays: United States
ID NLM: 8804099
Informations de publication
Date de publication:
05 2019
05 2019
Historique:
pubmed:
28
3
2019
medline:
24
3
2020
entrez:
28
3
2019
Statut:
ppublish
Résumé
Targeted screening for carbapenem-resistant organisms (CROs), including carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing organisms (CPOs), remains limited; recent data suggest that existing policies miss many carriers. Our objective was to measure the prevalence of CRO and CPO perirectal colonization at hospital unit admission and to use machine learning methods to predict probability of CRO and/or CPO carriage. We performed an observational cohort study of all patients admitted to the medical intensive care unit (MICU) or solid organ transplant (SOT) unit at The Johns Hopkins Hospital between July 1, 2016 and July 1, 2017. Admission perirectal swabs were screened for CROs and CPOs. More than 125 variables capturing preadmission clinical and demographic characteristics were collected from the electronic medical record (EMR) system. We developed models to predict colonization probabilities using decision tree learning. Evaluating 2,878 admission swabs from 2,165 patients, we found that 7.5% and 1.3% of swabs were CRO and CPO positive, respectively. Organism and carbapenemase diversity among CPO isolates was high. Despite including many characteristics commonly associated with CRO/CPO carriage or infection, overall, decision tree models poorly predicted CRO and CPO colonization (C statistics, 0.57 and 0.58, respectively). In subgroup analyses, however, models did accurately identify patients with recent CRO-positive cultures who use proton-pump inhibitors as having a high likelihood of CRO colonization. In this inpatient population, CRO carriage was infrequent but was higher than previously published estimates. Despite including many variables associated with CRO/CPO carriage, models poorly predicted colonization status, likely due to significant host and organism heterogeneity.
Sections du résumé
BACKGROUND
Targeted screening for carbapenem-resistant organisms (CROs), including carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing organisms (CPOs), remains limited; recent data suggest that existing policies miss many carriers.
OBJECTIVE
Our objective was to measure the prevalence of CRO and CPO perirectal colonization at hospital unit admission and to use machine learning methods to predict probability of CRO and/or CPO carriage.
METHODS
We performed an observational cohort study of all patients admitted to the medical intensive care unit (MICU) or solid organ transplant (SOT) unit at The Johns Hopkins Hospital between July 1, 2016 and July 1, 2017. Admission perirectal swabs were screened for CROs and CPOs. More than 125 variables capturing preadmission clinical and demographic characteristics were collected from the electronic medical record (EMR) system. We developed models to predict colonization probabilities using decision tree learning.
RESULTS
Evaluating 2,878 admission swabs from 2,165 patients, we found that 7.5% and 1.3% of swabs were CRO and CPO positive, respectively. Organism and carbapenemase diversity among CPO isolates was high. Despite including many characteristics commonly associated with CRO/CPO carriage or infection, overall, decision tree models poorly predicted CRO and CPO colonization (C statistics, 0.57 and 0.58, respectively). In subgroup analyses, however, models did accurately identify patients with recent CRO-positive cultures who use proton-pump inhibitors as having a high likelihood of CRO colonization.
CONCLUSIONS
In this inpatient population, CRO carriage was infrequent but was higher than previously published estimates. Despite including many variables associated with CRO/CPO carriage, models poorly predicted colonization status, likely due to significant host and organism heterogeneity.
Identifiants
pubmed: 30915928
pii: S0899823X19000424
doi: 10.1017/ice.2019.42
pmc: PMC6613376
mid: NIHMS1034815
doi:
Substances chimiques
Carbapenems
0
Types de publication
Journal Article
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
541-550Subventions
Organisme : NCEZID CDC HHS
ID : U01 CK000536
Pays : United States
Organisme : ACL HHS
ID : U54CK000447
Pays : United States
Organisme : ACL HHS
ID : U01CK000536
Pays : United States
Organisme : AHRQ HHS
ID : R36 HS025089
Pays : United States
Organisme : NIAID NIH HHS
ID : K24 AI141580
Pays : United States
Organisme : NCEZID CDC HHS
ID : U54 CK000447
Pays : United States
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