Prediction of bloodstream infection caused by extended-spectrum β-lactamase-producing Enterobacterales in patients with suspected community-onset sepsis

被引:9
|
作者
Froding, Inga [1 ,2 ]
Valik, John Karlsson [3 ,4 ]
Bolinder, Ludvig [4 ]
Naucler, Pontus [3 ,4 ]
Giske, Christian G. [1 ,2 ]
机构
[1] Karolinska Inst, Dept Lab Med, Stockholm, Sweden
[2] Karolinska Univ Lab, Dept Clin Microbiol, Bacteriol F72, S-14186 Stockholm, Sweden
[3] Karolinska Inst, Dept Med Solna, Stockholm, Sweden
[4] Karolinska Univ Hosp, Dept Infect Dis, Stockholm, Sweden
关键词
Prediction; Bacteraemia; Community-onset infection; Enterobacterales; Risk factors; ESCHERICHIA-COLI; RISK-FACTORS; MOLECULAR EPIDEMIOLOGY; EMPIRIC THERAPY; SEPTIC SHOCK; E; COLI; BACTEREMIA; MORTALITY; SCORE; METAANALYSIS;
D O I
10.1016/j.ijantimicag.2019.02.008
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Objectives: In severe infections, time to appropriate therapy is decisive for survival. Patients with bloodstream infection caused by extended-spectrum beta-lactamase-producing Enterobacterales (EPE-BSI) often receive inadequate empirical treatment. This study aimed to identify risk factors, to evaluate a previously suggested risk score and to suggest a new score for facilitating empirical treatment choice. Methods: Predictors for EPE-BSI were assessed through a retrospective case-control design. The diagnostic performance of the two scores was evaluated. Included patients had blood cultures sampled at four EDs in Stockholm (2012-2015), were admitted, and received antibiotics with activity against Gram negative bacilli. Results: A total of 277 EPE-BSI cases and 400 controls were included. The strongest predictor of EPEBSI was prior EPE-positive culture (cases 33% vs. controls 3%; multivariate (MV) OR = 19.1). Recent EPEpositivity within <= 3 months had a univariate OR of 32.8. Other major predictors were recent prostate biopsy (14% vs. 1%; MV OR = 22.2) and healthcare abroad (6% vs. 2%; MV OR = 3.9). Several previously suggested risk factors were not associated with EPE-BSI. The previously developed Utrecht score had a sensitivity of 54% and a specificity of 77%. The Stockholm score suggested herein (prior EPE-positive culture/prostate biopsy/healthcare abroad) showed comparable sensitivity (50%) but better specificity (96%). Prediction in patients lacking major predictors was difficult and caused high false-positive rates, which would cause unnecessary overtreatment. Conclusions: Prior EPE-positive culture, especially recently sampled, prostate biopsy and healthcare abroad were the strongest risk factors for community-onset EPE-BSI in Stockholm. Local data are needed when evaluating risk-scoring models before implementation. (C) 2019 Elsevier B.V. and International Society of Chemotherapy. All rights reserved.
引用
收藏
页码:820 / 829
页数:10
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