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Predicting resistant etiology in hospitalized patients with blood cultures positive for Gram-negative bacilli.
Eur J Intern Med. 2018 07; 53:21-28.EJ

Abstract

OBJECTIVE

To develop a risk-scoring tool to predict multidrug-resistant (MDR) etiology in patients with bloodstream infections (BSI) caused by Gram-negative bacilli (GNB).

METHODS

A prospective multicenter study analyzed patients with BSI hospitalized in 31 Internal Medicine wards in Italy from March 2012 to December 2012. Patients with BSI caused by MDR-GNB (non-susceptible to at least one agent in three antimicrobial categories) were compared to those with BSI due to susceptible GNB. A logistic regression to identify predictive factors of MDR-GNB was performed and the odds ratio (OR) were calculated. A score to predict the risk of MDR was developed.

RESULTS

Of 533 BSI episodes, 253 (47.5%) were caused by GNB. Among GNB-BSI, 122 (48.2%) were caused by MDR-GNB while 131 (51.8%) by non-MDR GNB. At multivariate analysis transfer from long-term care facility (OR 9.013, 95% CI 1.089-74.579, p = 0.041), hospitalization in the last 3 months (OR 2.882, 95% CI 1.580-5.259, p = 0.001), urinary catheter (OR 2.315, 95% CI 1.202-4.459, p = 0.012), antibiotic therapy in the last 3 months (OR 1.882, 95% CI 1.041-3.405, p = 0.036), age ≥ 75 years (OR 1.866, 95% CI 1.076-3.237, p = 0.026) were factors independently associated with MDR etiology. A score ranging from 0 to 10 was useful to recognize patients at lowest risk (0 points: Negative Likelihood Ratio 0.10) and those at highest risk (>6 points, Positive Likelihood Ratio 11.8) of GNB bacteremia due to a MDR strain.

CONCLUSIONS

Specific predictors of MDR etiology are useful to calculate probabilities of MDR etiology among hospitalized patients with blood cultures positive for GNB.

Authors+Show Affiliations

Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy. Electronic address: marco.falcone@uniroma1.it.Department of Internal Medicine and Medical Specialties, "Sapienza" University of Rome, Italy.Department of Clinical Medicine, Insubria University Varese, Italy.Internal Medicine Hospital of La Spezia, La Spezia, Italy.Centre for Research on Health Economics, Social and Health Care Management-CREMS, University Carlo Cattaneo-LIUC, Castellanza, Italy.Internal Medicine Ward, Hospital Media Valle del Tevere, Todi, Italy.Centre for Research on Health Economics, Social and Health Care Management-CREMS, University Carlo Cattaneo-LIUC, Castellanza, Italy.Internal Medicine Ward, Ospedale Civile, Legnano, Italy.Internal Medicine Ward, Hospital Media Valle del Tevere, Todi, Italy.Internal Medicine Ward, Ospedale Niguarda Ca' Granda, Milan, Italy.Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Italy.Infectious Diseases, Policlinico G.B. Rossi, University of Verona, Italy.Department of Internal Medicine, National Relevance and High Specialization Hospital Trust, ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy.Internal Medicine Ward, Ospedale Maggiore della Carità, Novara, Italy.Internal Medicine Ward, Ospedale Civile, Legnano, Italy.

Pub Type(s)

Journal Article
Multicenter Study
Observational Study

Language

eng

PubMed ID

29426676

Citation

Falcone, Marco, et al. "Predicting Resistant Etiology in Hospitalized Patients With Blood Cultures Positive for Gram-negative Bacilli." European Journal of Internal Medicine, vol. 53, 2018, pp. 21-28.
Falcone M, Tiseo G, Dentali F, et al. Predicting resistant etiology in hospitalized patients with blood cultures positive for Gram-negative bacilli. Eur J Intern Med. 2018;53:21-28.
Falcone, M., Tiseo, G., Dentali, F., La Regina, M., Foglia, E., Gambacorta, M., Garagiola, E., Bonardi, G., Clerici, P., Colombo, F., Farcomeni, A., Concia, E., Corrao, S., Campanini, M., & Mazzone, A. (2018). Predicting resistant etiology in hospitalized patients with blood cultures positive for Gram-negative bacilli. European Journal of Internal Medicine, 53, 21-28. https://doi.org/10.1016/j.ejim.2018.01.029
Falcone M, et al. Predicting Resistant Etiology in Hospitalized Patients With Blood Cultures Positive for Gram-negative Bacilli. Eur J Intern Med. 2018;53:21-28. PubMed PMID: 29426676.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predicting resistant etiology in hospitalized patients with blood cultures positive for Gram-negative bacilli. AU - Falcone,Marco, AU - Tiseo,Giusy, AU - Dentali,Francesco, AU - La Regina,Micaela, AU - Foglia,Emanuela, AU - Gambacorta,Maurizia, AU - Garagiola,Elisabetta, AU - Bonardi,Giorgio, AU - Clerici,Pierangelo, AU - Colombo,Fabrizio, AU - Farcomeni,Alessio, AU - Concia,Ercole, AU - Corrao,Salvatore, AU - Campanini,Mauro, AU - Mazzone,Antonino, Y1 - 2018/02/13/ PY - 2017/12/02/received PY - 2018/01/24/revised PY - 2018/01/30/accepted PY - 2018/2/11/pubmed PY - 2018/11/27/medline PY - 2018/2/11/entrez KW - Bloodstream infections KW - Gram-negative bacilli KW - Multidrug-resistant SP - 21 EP - 28 JF - European journal of internal medicine JO - Eur. J. Intern. Med. VL - 53 N2 - OBJECTIVE: To develop a risk-scoring tool to predict multidrug-resistant (MDR) etiology in patients with bloodstream infections (BSI) caused by Gram-negative bacilli (GNB). METHODS: A prospective multicenter study analyzed patients with BSI hospitalized in 31 Internal Medicine wards in Italy from March 2012 to December 2012. Patients with BSI caused by MDR-GNB (non-susceptible to at least one agent in three antimicrobial categories) were compared to those with BSI due to susceptible GNB. A logistic regression to identify predictive factors of MDR-GNB was performed and the odds ratio (OR) were calculated. A score to predict the risk of MDR was developed. RESULTS: Of 533 BSI episodes, 253 (47.5%) were caused by GNB. Among GNB-BSI, 122 (48.2%) were caused by MDR-GNB while 131 (51.8%) by non-MDR GNB. At multivariate analysis transfer from long-term care facility (OR 9.013, 95% CI 1.089-74.579, p = 0.041), hospitalization in the last 3 months (OR 2.882, 95% CI 1.580-5.259, p = 0.001), urinary catheter (OR 2.315, 95% CI 1.202-4.459, p = 0.012), antibiotic therapy in the last 3 months (OR 1.882, 95% CI 1.041-3.405, p = 0.036), age ≥ 75 years (OR 1.866, 95% CI 1.076-3.237, p = 0.026) were factors independently associated with MDR etiology. A score ranging from 0 to 10 was useful to recognize patients at lowest risk (0 points: Negative Likelihood Ratio 0.10) and those at highest risk (>6 points, Positive Likelihood Ratio 11.8) of GNB bacteremia due to a MDR strain. CONCLUSIONS: Specific predictors of MDR etiology are useful to calculate probabilities of MDR etiology among hospitalized patients with blood cultures positive for GNB. SN - 1879-0828 UR - https://www.unboundmedicine.com/medline/citation/29426676/Predicting_resistant_etiology_in_hospitalized_patients_with_blood_cultures_positive_for_Gram_negative_bacilli_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0953-6205(18)30045-1 DB - PRIME DP - Unbound Medicine ER -