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A simple scoring algorithm predicting extended-spectrum β-lactamase producers in adults with community-onset monomicrobial Enterobacteriaceae bacteremia: Matters of frequent emergency department users.

Abstract The incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBL-producer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB).In a retrospective cohort, multicenter study, adults with CoMEB in the emergency department (ED) were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype. Clinical information was obtained from chart records.Of the total 1141 adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs)-recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98)-were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6%) and an acceptable specificity (92.5%); the area under the receiver operating characteristic curve was 0.92.In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28422867
OWN - NLM
STAT- In-Process
DA  - 20170419
LR  - 20170419
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 16
DP  - 2017 Apr
TI  - A simple scoring algorithm predicting extended-spectrum beta-lactamase producers 
      in adults with community-onset monomicrobial Enterobacteriaceae bacteremia:
      Matters of frequent emergency department users.
PG  - e6648
LID - 10.1097/MD.0000000000006648 [doi]
AB  - The incidence of community-onset bacteremia caused by
      extended-spectrum-beta-lactamase (ESBL) producers is increasing. The adverse
      effects of ESBL production on patient outcome have been recognized and this
      antimicrobial resistance has significant implications in the delay of appropriate
      therapy. However, a simple scoring algorithm that can easily, inexpensively, and 
      accurately be applied to clinical settings was lacking. Thus, we established a
      predictive scoring algorithm for identifying patients at the risk of
      ESBL-producer infections among patients with community-onset monomicrobial
      Enterobacteriaceae bacteremia (CoMEB).In a retrospective cohort, multicenter
      study, adults with CoMEB in the emergency department (ED) were recruited during
      January 2008 to December 2013. ESBL producers were determined based on ESBL
      phenotype. Clinical information was obtained from chart records.Of the total 1141
      adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four
      independent multivariate predictors of ESBL-producer bacteremia with high odds
      ratios (ORs)-recent antimicrobial use (OR, 15.29), recent invasive procedures
      (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR,
      9.98)-were each assigned +1 point to obtain the CoMEB-ESBL score. Using the
      proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity
      (84.6%) and an acceptable specificity (92.5%); the area under the receiver
      operating characteristic curve was 0.92.In conclusion, this simple scoring
      algorithm can be used to identify CoMEB patients with a high ESBL-producer
      infection risk. Of note, frequent ED user was firstly demonstrated to be a
      crucial predictor in predicting ESBL-producer infections. ED clinicians should
      consider adequate empirical therapy with coverage of these pathogens for patients
      with risk factors.
FAU - Lee, Chung-Hsun
AU  - Lee CH
AD  - aDepartment of Emergency Medicine, National Cheng Kung University Hospital
      bDepartment of Medicine, National Cheng Kung University Medical College
      cDepartment of Emergency Medicine, Chi-Mei Medical Center dDepartment of Internal
      Medicine, National Cheng Kung University Hospital eDivision of Critical Care
      Medicine, Department of Internal Medicine, Madou Sin-Lau Hospital fGraduate
      Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian
      University, Tainan, Taiwan.
FAU - Chu, Feng-Yuan
AU  - Chu FY
FAU - Hsieh, Chih-Chia
AU  - Hsieh CC
FAU - Hong, Ming-Yuan
AU  - Hong MY
FAU - Chi, Chih-Hsien
AU  - Chi CH
FAU - Ko, Wen-Chien
AU  - Ko WC
FAU - Lee, Ching-Chi
AU  - Lee CC
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/04/20 06:00
MHDA- 2017/04/20 06:00
CRDT- 2017/04/20 06:00
AID - 10.1097/MD.0000000000006648 [doi]
AID - 00005792-201704210-00048 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Apr;96(16):e6648. doi: 10.1097/MD.0000000000006648.

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