Derivation and validation of a simple score to predict the presence of bacteria requiring carbapenem treatment in ICU-acquired bloodstream infection and pneumonia: CarbaSCORE

Abstract

BackgroundThe recommendations of learned societies mention risk factors for the presence of multidrug resistant bacteria in hospital-acquired infections, but they do not propose a scoring system to guide empiric antibiotic therapy. Our study was aimed at developing a simple score for predicting “the presence of bacteria requiring carbapenem treatment” in ICU-acquired bloodstream infection and pneumonia.MethodsBetween December 2011 and January 2015, we conducted a retrospective study using a prospectively collected French database of nosocomial infections in the polyvalent intensive care unit of a French university hospital. All patients with ICU-acquired bloodstream infection or pneumonia were included in the study. Bivariate and multivariate analyses were performed to develop the CarbaSCORE, and this score was internally validated.ResultsIn total, 338 patients were analyzed, including 27 patients requiring carbapenem treatment. The CarbaSCORE was composed of four criteria: “presence of bloodstream infection” (as opposed to pneumonia) scored 2 points, “chronic hemodialysis” scored 4 points, “travel abroad in the last 6 months” scored 5 points, and “MDR-colonization or prior use of a β-lactam of class ≥ 3” scored 6 points. Internal validation by bootstrapping showed an area under the receiver operating characteristic curve of 0.81 [0.73–0.89]. Sensitivity was 96% at the 6-point threshold and specificity was 91% at the 9-point threshold.ConclusionsThe CarbaSCORE is a simple and efficient score for predicting the presence of bacteria requiring carbapenem treatment. Further studies are needed to test this score before it can be used in practice.