Abstract
In the era of widespread resistance, there are 2 time points at which most empiric prescription errors occur among hospitalized adults: (1) upon admission (UA) when treating patients at risk of multidrug-resistant organisms (MDROs) and (2) during hospitalization, when treating patients at risk of extensively drug-resistant organisms (XDROs). These errors adversely influence patient outcomes and the hospital's ecology. Retrospective cohort study, Shamir Medical Center, Israel, 2016. Adult patients (aged >18 years) hospitalized with sepsis. Logistic regressions were used to develop predictive models for (1) MDRO UA and (2) nosocomial XDRO. Their performances on the derivation data sets, and on 7 other validation data sets, were assessed using the area under the receiver operating characteristic curve (ROC AUC). In total, 4,114 patients were included: 2,472 patients with sepsis UA and 1,642 with nosocomial sepsis. The MDRO UA score included 10 parameters, and with a cutoff of ≥22 points, it had an ROC AUC of 0.85. The nosocomial XDRO score included 7 parameters, and with a cutoff of ≥36 points, it had an ROC AUC of 0.87. The range of ROC AUCs for the validation data sets was 0.7-0.88 for the MDRO UA score and was 0.66-0.75 for nosocomial XDRO score. We created a free web calculator (https://assafharofe.azurewebsites.net). A simple electronic calculator could aid with empiric prescription during an encounter with a septic patient. Future implementation studies are needed to evaluate its utility in improving patient outcomes and in reducing overall resistances.
Highlights
We aimed to generate a simple electronic calculator to predict both Multidrug-resistant organisms (MDROs) upon admission (UA) and nosocomial XDRO infections, and only require parameters to be entered which are readily available at the bedside
The second is in cases of nosocomial infection, with regard to XDROs, such as vancomycin-resistant Enterococcus (VRE),[17] and carbapenem-nonsusceptible gram-negative bacteria, such as Enterobacterales (CRE),[18] Acinetobacter baumannii (CRAB),[19] and P. aeruginosa (CRPA).[20]
The derivation data set for the MDRO UA score consisted of patients with sepsis admitted to the emergency room from August 28, 2016, to December 12, 2016
Summary
We aimed to generate a simple electronic calculator to predict both MDRO UA and nosocomial XDRO infections, and only require parameters to be entered which are readily available at the bedside. The derivation data set for the nosocomial XDRO score consisted of hospitalized septic patients from the entire calendar year of 2016.
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