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Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection on Hospital Admission.
Infect Control Hosp Epidemiol. 2017 10; 38(10):1216-1225.IC

Abstract

OBJECTIVE

Isolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care.

METHODS

A 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures.

RESULTS

A score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06-3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57-8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24-4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39-4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16-4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001).

CONCLUSION

A model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB. Infect Control Hosp Epidemiol 2017;38:1216-1225.

Authors+Show Affiliations

1Department of Emergency Medicine,National Taiwan University Hospital,College of Medicine,National Taiwan University,Taipei,Taiwan.2Department of Internal Medicine,National Taiwan University Hospital,College of Medicine,National Taiwan University,Taipei,Taiwan.4Department of Nursing,National Taiwan University Hospital,Taipei,Taiwan.1Department of Emergency Medicine,National Taiwan University Hospital,College of Medicine,National Taiwan University,Taipei,Taiwan.1Department of Emergency Medicine,National Taiwan University Hospital,College of Medicine,National Taiwan University,Taipei,Taiwan.3Center for Infection Control,National Taiwan University Hospital,College of Medicine,National Taiwan University,Taipei,Taiwan.1Department of Emergency Medicine,National Taiwan University Hospital,College of Medicine,National Taiwan University,Taipei,Taiwan.2Department of Internal Medicine,National Taiwan University Hospital,College of Medicine,National Taiwan University,Taipei,Taiwan.1Department of Emergency Medicine,National Taiwan University Hospital,College of Medicine,National Taiwan University,Taipei,Taiwan.

Pub Type(s)

Journal Article
Validation Study

Language

eng

PubMed ID

28870265

Citation

Tseng, Wen-Pin, et al. "Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection On Hospital Admission." Infection Control and Hospital Epidemiology, vol. 38, no. 10, 2017, pp. 1216-1225.
Tseng WP, Chen YC, Yang BJ, et al. Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection on Hospital Admission. Infect Control Hosp Epidemiol. 2017;38(10):1216-1225.
Tseng, W. P., Chen, Y. C., Yang, B. J., Chen, S. Y., Lin, J. J., Huang, Y. H., Fu, C. M., Chang, S. C., & Chen, S. Y. (2017). Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection on Hospital Admission. Infection Control and Hospital Epidemiology, 38(10), 1216-1225. https://doi.org/10.1017/ice.2017.178
Tseng WP, et al. Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection On Hospital Admission. Infect Control Hosp Epidemiol. 2017;38(10):1216-1225. PubMed PMID: 28870265.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection on Hospital Admission. AU - Tseng,Wen-Pin, AU - Chen,Yee-Chun, AU - Yang,Bey-Jing, AU - Chen,Shang-Yu, AU - Lin,Jr-Jiun, AU - Huang,Ya-Huei, AU - Fu,Chia-Ming, AU - Chang,Shan-Chwen, AU - Chen,Shey-Ying, Y1 - 2017/09/05/ PY - 2017/9/6/pubmed PY - 2018/5/22/medline PY - 2017/9/6/entrez SP - 1216 EP - 1225 JF - Infection control and hospital epidemiology JO - Infect Control Hosp Epidemiol VL - 38 IS - 10 N2 - OBJECTIVE Isolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care. METHODS A 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures. RESULTS A score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06-3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57-8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24-4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39-4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16-4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001). CONCLUSION A model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB. Infect Control Hosp Epidemiol 2017;38:1216-1225. SN - 1559-6834 UR - https://www.unboundmedicine.com/medline/citation/28870265/Predicting_Multidrug_Resistant_Gram_Negative_Bacterial_Colonization_and_Associated_Infection_on_Hospital_Admission_ L2 - https://www.cambridge.org/core/product/identifier/S0899823X17001787/type/journal_article DB - PRIME DP - Unbound Medicine ER -