An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales.
Bacteraemia
ESBL
antibiotic resistance
antibiotics
bloodstream infection
Journal
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
ISSN: 1537-6591
Titre abrégé: Clin Infect Dis
Pays: United States
ID NLM: 9203213
Informations de publication
Date de publication:
06 12 2021
06 12 2021
Historique:
received:
21
02
2020
accepted:
03
07
2020
pubmed:
9
7
2020
medline:
15
3
2022
entrez:
9
7
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32640024
pii: 5868963
doi: 10.1093/cid/ciaa950
pmc: PMC8849131
doi:
Substances chimiques
Anti-Bacterial Agents
0
Cephalosporins
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e4475-e4483Informations de copyright
© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.
Références
Clin Infect Dis. 2016 Oct 1;63(7):896-903
pubmed: 27358356
Clin Microbiol Infect. 2015 Apr;21(4):302-12
pubmed: 25743999
Clin Microbiol Infect. 2018 Dec;24(12):1315-1321
pubmed: 29581056
Ochsner J. 2001 Apr;3(2):85-93
pubmed: 21765724
Infect Dis (Lond). 2019 Jan;51(1):32-37
pubmed: 30371118
Clin Infect Dis. 2009 Mar 1;48(5):580-6
pubmed: 19191643
Medicine (Baltimore). 2017 Apr;96(16):e6648
pubmed: 28422867
Cochrane Database Syst Rev. 2014 Jan 07;(1):CD003344
pubmed: 24395715
Antimicrob Agents Chemother. 2011 Jul;55(7):3485-90
pubmed: 21537020
Int J Antimicrob Agents. 2019 Jun;53(6):820-829
pubmed: 30779954
J Clin Epidemiol. 2005 May;58(5):475-83
pubmed: 15845334
BMC Med Res Methodol. 2014 Mar 19;14:40
pubmed: 24645774
J Hosp Infect. 2016 May;93(1):49-56
pubmed: 26905665
Trials. 2012 Aug 16;13:137
pubmed: 22897974
BMC Med. 2019 Dec 16;17(1):230
pubmed: 31842878
J Antimicrob Chemother. 2018 Mar 1;73(suppl_3):iii2-iii78
pubmed: 29514274
J Antimicrob Chemother. 2012 Jun;67(6):1311-20
pubmed: 22396430
Clin Infect Dis. 2015 Jun 1;60(11):1622-30
pubmed: 25694654