Abstract
BackgroundWe developed a clinical bedside tool to simultaneously estimate the probabilities of third-generation cephalosporin-resistant Enterobacteriaceae (3GC-R), carbapenem-resistant Enterobacteriaceae (CRE), and multidrug-resistant Pseudomonas aeruginosa (MDRP) among hospitalized adult patients with Gram-negative infections.MethodsData were obtained from a retrospective observational study of the Premier Hospital that included hospitalized adult patients with a complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), hospital-acquired/ventilator-associated pneumonia (HAP/VAP), or bloodstream infection (BSI) due to Gram-negative bacteria between 2011 and 2015. Risk factors for 3GC-R, CRE, and MDRP were ascertained by multivariate logistic regression, and separate models were developed for patients with community-acquired versus hospital-acquired infections for each resistance phenotype (N = 6). Models were converted to a singular user-friendly interface to estimate the probabilities of a patient having an infection due to 3GC-R, CRE, or MDRP when ≥ 1 risk factor was present.ResultsOverall, 124,068 patients contributed to the dataset. Percentages of patients admitted for cUTI, cIAI, HAP/VAP, and BSI were 61.6, 4.6, 16.5, and 26.4%, respectively (some patients contributed > 1 infection type). Resistant infection rates were 1.90% for CRE, 12.09% for 3GC-R, and 3.91% for MDRP. A greater percentage of the resistant infections were community-acquired relative to hospital-acquired (CRE, 1.30% vs 0.62% of 1.90%; 3GC-R, 9.27% vs 3.42% of 12.09%; MDRP, 2.39% vs 1.59% of 3.91%). The most important predictors of having an 3GC-R, CRE or MDRP infection were prior number of antibiotics; infection site; infection during the previous 3 months; and hospital prevalence of 3GC-R, CRE, or MDRP. To enable application of the six predictive multivariate logistic regression models to real-world clinical practice, we developed a user-friendly interface that estimates the risk of 3GC-R, CRE, and MDRP simultaneously in a given patient with a Gram-negative infection based on their risk (Additional file 1).ConclusionsWe developed a clinical prediction tool to estimate the probabilities of 3GC-R, CRE, and MDRP among hospitalized adult patients with confirmed community- and hospital-acquired Gram-negative infections. Our predictive model has been implemented as a user-friendly bedside tool for use by clinicians/healthcare professionals to predict the probability of resistant infections in individual patients, to guide early appropriate therapy.
Highlights
We developed a clinical bedside tool to simultaneously estimate the probabilities of third-generation cephalosporin-resistant Enterobacteriaceae (3GC-R), carbapenem-resistant Enterobacteriaceae (CRE), and multidrugresistant Pseudomonas aeruginosa (MDRP) among hospitalized adult patients with Gram-negative infections
There is a general appreciation of patient-level risk factors and exposures that increase the probability of having an infection due to 3GC-R, CRE, or MDRP, there are no widely available and readily adaptable tools for estimating the likelihood of having one of these resistant Gram-negative pathogens simultaneously in individual patients according to the presence or absence of critical hospital- and patient-level covariates. To address this unmet need, the goal of this study was to develop a user-friendly clinical tool that simultaneously estimates the likelihood of having an infection due to 3GC-R, CRE, or MDRP when one or more risk factors are present among patients with infections due to Gram-negative bacteria
Patients included in the study population were adults (≥18 years) who had ≥1 admission to a hospital with evidence of a complicated urinary tract infection, complicated intra-abdominal infection, hospitalacquired or ventilator-associated pneumonia (HAP/ VAP), or bloodstream infection (BSI) (Additional file 2)
Summary
We developed a clinical bedside tool to simultaneously estimate the probabilities of third-generation cephalosporin-resistant Enterobacteriaceae (3GC-R), carbapenem-resistant Enterobacteriaceae (CRE), and multidrugresistant Pseudomonas aeruginosa (MDRP) among hospitalized adult patients with Gram-negative infections. Three of the more concerning antibiotic-resistant Gram-negative pathogens that are classified as serious or urgent threats to public health include third-generation cephalosporin-resistant Enterobacteriaceae (3GC-R), carbapenem-resistant Enterobacteriaceae (CRE), and multidrug-resistant Pseudomonas aeruginosa (MDRP) [1, 2]. Prolonged hospitalization places patients at risk of developing subsequent antibiotic-resistant infections [3, 11], which can lead to further antibiotic usage [5] and exacerbate institutional antimicrobial resistance patterns [12, 13]
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