W C Rottier1, C H van Werkhoven2, Y R P Bamberg2, J W Dorigo-Zetsma3, E M van de Garde4, B C van Hees5, J A J W Kluytmans6, E M Kuck7, P D van der Linden8, J M Prins9, S F T Thijsen10, A Verbon11, B J M Vlaminckx12, H S M Ammerlaan2, M J M Bonten13. 1. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands. Electronic address: w.c.rottier-2@umcutrecht.nl. 2. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands. 3. Central Laboratory for Bacteriology and Serology, Tergooi Hospitals, Hilversum, The Netherlands. 4. Department of Clinical Pharmacy, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands. 5. Department of Medical Microbiology and Infection Control, Gelre Hospitals, Apeldoorn, The Netherlands. 6. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands; Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands. 7. Department of Hospital Pharmacy, Diakonessenhuis, Utrecht, The Netherlands. 8. Department of Clinical Pharmacy, Tergooi Hospitals, Hilversum, The Netherlands. 9. Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. 10. Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, The Netherlands. 11. Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands. 12. Department of Medical Microbiology and Immunology, St. Antonius Hospital, Utrecht/Nieuwegein, The Netherlands. 13. Julius Center for Health Sciences and Primary Care, University Medical Centre Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
OBJECTIVES: Current guidelines for the empirical antibiotic treatment predict the presence of third-generation cephalosporin-resistant enterobacterial bacteraemia (3GCR-E-Bac) in case of infection only poorly, thereby increasing unnecessary carbapenem use. We aimed to develop diagnostic scoring systems which can better predict the presence of 3GCR-E-Bac. METHODS: A retrospective nested case-control study was performed that included patients ≥18 years of age from eight Dutch hospitals in whom blood cultures were obtained and intravenous antibiotics were initiated. Each patient with 3GCR-E-Bac was matched to four control infection episodes within the same hospital, based on blood-culture date and onset location (community or hospital). Starting from 32 commonly described clinical risk factors at infection onset, selection strategies were used to derive scoring systems for the probability of community- and hospital-onset 3GCR-E-Bac. RESULTS: 3GCR-E-Bac occurred in 90 of 22 506 (0.4%) community-onset infections and in 82 of 8110 (1.0%) hospital-onset infections, and these cases were matched to 360 community-onset and 328 hospital-onset control episodes. The derived community-onset and hospital-onset scoring systems consisted of six and nine predictors, respectively. With selected score cut-offs, the models identified 3GCR-E-Bac with sensitivity equal to existing guidelines (community-onset: 54.3%; hospital-onset: 81.5%). However, they reduced the proportion of patients classified as at risk for 3GCR-E-Bac (i.e. eligible for empirical carbapenem therapy) with 40% (95%CI 21-56%) and 49% (95%CI 39-58%) in, respectively, community-onset and hospital-onset infections. CONCLUSIONS: These prediction scores for 3GCR-E-Bac, specifically geared towards the initiation of empirical antibiotic treatment, may improve the balance between inappropriate antibiotics and carbapenem overuse.
OBJECTIVES: Current guidelines for the empirical antibiotic treatment predict the presence of third-generation cephalosporin-resistant enterobacterial bacteraemia (3GCR-E-Bac) in case of infection only poorly, thereby increasing unnecessary carbapenem use. We aimed to develop diagnostic scoring systems which can better predict the presence of 3GCR-E-Bac. METHODS: A retrospective nested case-control study was performed that included patients ≥18 years of age from eight Dutch hospitals in whom blood cultures were obtained and intravenous antibiotics were initiated. Each patient with 3GCR-E-Bac was matched to four control infection episodes within the same hospital, based on blood-culture date and onset location (community or hospital). Starting from 32 commonly described clinical risk factors at infection onset, selection strategies were used to derive scoring systems for the probability of community- and hospital-onset 3GCR-E-Bac. RESULTS: 3GCR-E-Bac occurred in 90 of 22 506 (0.4%) community-onset infections and in 82 of 8110 (1.0%) hospital-onset infections, and these cases were matched to 360 community-onset and 328 hospital-onset control episodes. The derived community-onset and hospital-onset scoring systems consisted of six and nine predictors, respectively. With selected score cut-offs, the models identified 3GCR-E-Bac with sensitivity equal to existing guidelines (community-onset: 54.3%; hospital-onset: 81.5%). However, they reduced the proportion of patients classified as at risk for 3GCR-E-Bac (i.e. eligible for empirical carbapenem therapy) with 40% (95%CI 21-56%) and 49% (95%CI 39-58%) in, respectively, community-onset and hospital-onset infections. CONCLUSIONS: These prediction scores for 3GCR-E-Bac, specifically geared towards the initiation of empirical antibiotic treatment, may improve the balance between inappropriate antibiotics and carbapenem overuse.
Authors: Laura Evans; Andrew Rhodes; Waleed Alhazzani; Massimo Antonelli; Craig M Coopersmith; Craig French; Flávia R Machado; Lauralyn Mcintyre; Marlies Ostermann; Hallie C Prescott; Christa Schorr; Steven Simpson; W Joost Wiersinga; Fayez Alshamsi; Derek C Angus; Yaseen Arabi; Luciano Azevedo; Richard Beale; Gregory Beilman; Emilie Belley-Cote; Lisa Burry; Maurizio Cecconi; John Centofanti; Angel Coz Yataco; Jan De Waele; R Phillip Dellinger; Kent Doi; Bin Du; Elisa Estenssoro; Ricard Ferrer; Charles Gomersall; Carol Hodgson; Morten Hylander Møller; Theodore Iwashyna; Shevin Jacob; Ruth Kleinpell; Michael Klompas; Younsuck Koh; Anand Kumar; Arthur Kwizera; Suzana Lobo; Henry Masur; Steven McGloughlin; Sangeeta Mehta; Yatin Mehta; Mervyn Mer; Mark Nunnally; Simon Oczkowski; Tiffany Osborn; Elizabeth Papathanassoglou; Anders Perner; Michael Puskarich; Jason Roberts; William Schweickert; Maureen Seckel; Jonathan Sevransky; Charles L Sprung; Tobias Welte; Janice Zimmerman; Mitchell Levy Journal: Intensive Care Med Date: 2021-10-02 Impact factor: 17.440
Authors: Elske Sieswerda; Hannelore I Bax; Jacobien J Hoogerwerf; Mark G J de Boer; Marja Boermeester; Marc J M Bonten; Douwe Dekker; Roy Gerth van Wijk; Nicole P Juffermans; Marnix Kuindersma; Paul D van der Linden; Damian C Melles; Peter Pickkers; Jeroen A Schouten; Jasper R Rebel; Arthur R H van Zanten; Jan M Prins; W Joost Wiersinga Journal: BMC Infect Dis Date: 2022-08-11 Impact factor: 3.667
Authors: Merel M C Lambregts; Bart J C Hendriks; Leo G Visser; Sandra T Bernards; Mark G J de Boer Journal: Antimicrob Resist Infect Control Date: 2019-01-25 Impact factor: 4.887
Authors: Pepijn Huizinga; Marjolein Kluytmans-van den Bergh; John W Rossen; Ina Willemsen; Carlo Verhulst; Paul H M Savelkoul; Alexander W Friedrich; Silvia García-Cobos; Jan Kluytmans Journal: PLoS One Date: 2019-12-31 Impact factor: 3.240
Authors: J W Timotëus Deelen; Wouter C Rottier; José A Giron Ortega; Jesús Rodriguez-Baño; Stephan Harbarth; Evelina Tacconelli; Gunnar Jacobsson; Jean-Ralph Zahar; Cornelis H van Werkhoven; Marc J M Bonten Journal: Clin Infect Dis Date: 2021-12-06 Impact factor: 9.079