Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients

Jianfeng Xie,Yi Yang,Xudong Ma,Min Mo,Fengmei Guo,Haibo Qiu,Yingzi Huang,Markus M Heimesaat

doi:10.1371/journal.pone.0089687

Abstract

BackgroundThe incidence rate of infection by multidrug-resistant organisms (MDROs) can affect the accuracy of etiological diagnosis when using American Thoracic Society (ATS) guidelines. We determined the accuracy of the ATS guidelines in predicting infection or colonization by MDROs over 18 months at a single ICU in eastern China.MethodsThis prospective observational study examined consecutive patients who were admitted to an intensive care unit (ICU) in Nanjing, China. MDROs were defined as bacteria that were resistant to at least three antimicrobial classes, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Pseudomonas aeruginosa, Acinetobacter baumannii. Screening for MDROs was performed at ICU admission and discharge. Risk factors for infection or colonization with MDROs were recorded, and the accuracy of the ATS guidelines in predicting infection or colonization with MDROs was documented.ResultsThere were 610 patients, 225 (37%) of whom were colonized or infected with MDROs at ICU admission, and this increased to 311 (51%) at discharge. At admission, the sensitivity (70.0%), specificity (31.6%), positive predictive value (38.2%), and negative predictive value (63.5%), all based on ATS guidelines for infection or colonization with MDROs were low. The negative predictive value was greater in patients from departments with MDRO infection rates of 31–40% than in patients from departments with MDRO infection rates of 30% or less and from departments with MDRO infection rates more than 40%.ConclusionATS criteria were not reliable in predicting infection or colonization with MDROs in our ICU. The negative predictive value was greater in patients from departments with intermediate rates of MDRO infection than in patients from departments with low or high rates of MDRO infection.Trial Registration ClinicalTrials.gov NCT01667991

Highlights

Sepsis is a common cause of morbidity and mortality in critically ill patients [1,2]
The guidelines were developed for management of patients with pneumonia, the risk factors for infection with an multidrug-resistant organisms (MDROs) are similar for patients with other types of infections, such as bloodstream infection [14]
MDROs were defined as bacteria that were resistant to at least three antimicrobial classes, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Pseudomonas aeruginosa, Acinetobacter baumannii, and extended-spectrum b-lactamase (ESBL)-producing Gram-negative bacilli based on laboratory testing

Summary

Introduction

Sepsis is a common cause of morbidity and mortality in critically ill patients [1,2]. In 2005, the American Thoracic Society (ATS) published guidelines [13] for treatment of patients with healthcare-associated pneumonia. These guidelines recommend selection of an initial empiric therapy based on the presence of risk factors for MDROs. the guidelines were developed for management of patients with pneumonia, the risk factors for infection with an MDRO are similar for patients with other types of infections, such as bloodstream infection [14]. The MDRO-related risk factors identified in the ATS guidelines may be helpful in guiding initial antibiotic treatment of such patients. The incidence rate of infection by multidrug-resistant organisms (MDROs) can affect the accuracy of etiological diagnosis when using American Thoracic Society (ATS) guidelines. We determined the accuracy of the ATS guidelines in predicting infection or colonization by MDROs over 18 months at a single ICU in eastern China

Methods

Results

Conclusion