Predicting resistant etiology in hospitalized patients with blood cultures positive for Gram-negative bacilli
Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved..
OBJECTIVE: To develop a risk-scoring tool to predict multidrug-resistant (MDR) etiology in patients with bloodstream infections (BSI) caused by Gram-negative bacilli (GNB).
METHODS: A prospective multicenter study analyzed patients with BSI hospitalized in 31 Internal Medicine wards in Italy from March 2012 to December 2012. Patients with BSI caused by MDR-GNB (non-susceptible to at least one agent in three antimicrobial categories) were compared to those with BSI due to susceptible GNB. A logistic regression to identify predictive factors of MDR-GNB was performed and the odds ratio (OR) were calculated. A score to predict the risk of MDR was developed.
RESULTS: Of 533 BSI episodes, 253 (47.5%) were caused by GNB. Among GNB-BSI, 122 (48.2%) were caused by MDR-GNB while 131 (51.8%) by non-MDR GNB. At multivariate analysis transfer from long-term care facility (OR 9.013, 95% CI 1.089-74.579, p = 0.041), hospitalization in the last 3 months (OR 2.882, 95% CI 1.580-5.259, p = 0.001), urinary catheter (OR 2.315, 95% CI 1.202-4.459, p = 0.012), antibiotic therapy in the last 3 months (OR 1.882, 95% CI 1.041-3.405, p = 0.036), age ≥ 75 years (OR 1.866, 95% CI 1.076-3.237, p = 0.026) were factors independently associated with MDR etiology. A score ranging from 0 to 10 was useful to recognize patients at lowest risk (0 points: Negative Likelihood Ratio 0.10) and those at highest risk (>6 points, Positive Likelihood Ratio 11.8) of GNB bacteremia due to a MDR strain.
CONCLUSIONS: Specific predictors of MDR etiology are useful to calculate probabilities of MDR etiology among hospitalized patients with blood cultures positive for GNB.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2018 |
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| Erschienen: |
2018 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:53 |
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| Enthalten in: |
European journal of internal medicine - 53(2018) vom: 17. Juli, Seite 21-28 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Falcone, Marco [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-Bacterial Agents |
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| Anmerkungen: |
Date Completed 26.11.2018 Date Revised 26.11.2018 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ejim.2018.01.029 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM280858191 |
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| 245 | 1 | 0 | |a Predicting resistant etiology in hospitalized patients with blood cultures positive for Gram-negative bacilli |
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| 500 | |a Date Completed 26.11.2018 | ||
| 500 | |a Date Revised 26.11.2018 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. | ||
| 520 | |a OBJECTIVE: To develop a risk-scoring tool to predict multidrug-resistant (MDR) etiology in patients with bloodstream infections (BSI) caused by Gram-negative bacilli (GNB) | ||
| 520 | |a METHODS: A prospective multicenter study analyzed patients with BSI hospitalized in 31 Internal Medicine wards in Italy from March 2012 to December 2012. Patients with BSI caused by MDR-GNB (non-susceptible to at least one agent in three antimicrobial categories) were compared to those with BSI due to susceptible GNB. A logistic regression to identify predictive factors of MDR-GNB was performed and the odds ratio (OR) were calculated. A score to predict the risk of MDR was developed | ||
| 520 | |a RESULTS: Of 533 BSI episodes, 253 (47.5%) were caused by GNB. Among GNB-BSI, 122 (48.2%) were caused by MDR-GNB while 131 (51.8%) by non-MDR GNB. At multivariate analysis transfer from long-term care facility (OR 9.013, 95% CI 1.089-74.579, p = 0.041), hospitalization in the last 3 months (OR 2.882, 95% CI 1.580-5.259, p = 0.001), urinary catheter (OR 2.315, 95% CI 1.202-4.459, p = 0.012), antibiotic therapy in the last 3 months (OR 1.882, 95% CI 1.041-3.405, p = 0.036), age ≥ 75 years (OR 1.866, 95% CI 1.076-3.237, p = 0.026) were factors independently associated with MDR etiology. A score ranging from 0 to 10 was useful to recognize patients at lowest risk (0 points: Negative Likelihood Ratio 0.10) and those at highest risk (>6 points, Positive Likelihood Ratio 11.8) of GNB bacteremia due to a MDR strain | ||
| 520 | |a CONCLUSIONS: Specific predictors of MDR etiology are useful to calculate probabilities of MDR etiology among hospitalized patients with blood cultures positive for GNB | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Bloodstream infections | |
| 650 | 4 | |a Gram-negative bacilli | |
| 650 | 4 | |a Multidrug-resistant | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Tiseo, Giusy |e verfasserin |4 aut | |
| 700 | 1 | |a Dentali, Francesco |e verfasserin |4 aut | |
| 700 | 1 | |a La Regina, Micaela |e verfasserin |4 aut | |
| 700 | 1 | |a Foglia, Emanuela |e verfasserin |4 aut | |
| 700 | 1 | |a Gambacorta, Maurizia |e verfasserin |4 aut | |
| 700 | 1 | |a Garagiola, Elisabetta |e verfasserin |4 aut | |
| 700 | 1 | |a Bonardi, Giorgio |e verfasserin |4 aut | |
| 700 | 1 | |a Clerici, Pierangelo |e verfasserin |4 aut | |
| 700 | 1 | |a Colombo, Fabrizio |e verfasserin |4 aut | |
| 700 | 1 | |a Farcomeni, Alessio |e verfasserin |4 aut | |
| 700 | 1 | |a Concia, Ercole |e verfasserin |4 aut | |
| 700 | 1 | |a Corrao, Salvatore |e verfasserin |4 aut | |
| 700 | 1 | |a Campanini, Mauro |e verfasserin |4 aut | |
| 700 | 1 | |a Mazzone, Antonino |e verfasserin |4 aut | |
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