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Predicting resistant etiology in hospitalized patients with blood cultures positive for Gram-negative bacilli

Published:February 06, 2018DOI:https://doi.org/10.1016/j.ejim.2018.01.029

      Highlights

      • It is very important to ensure an adequate empirical therapy in patients with bacteremia due to Gram-negative bacilli
      • We assessed the independent risk factors for bacteremia caused by a resistant strain.
      • We developed a score for a bedside estimation of the risk of multidrug-resistant etiology.
      • The score is an easy instrument to guide the decision of the most appropriate initial antibiotic therapy strain in septic patients.

      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.

      Abbreviations:

      BSI (bloodstream infections), CDC (Centers for Disease Control and Prevention), COPD (chronic obstructive pulmonary disease), CRE (carbapenem-resistant Enterobacteriaceae), ESBL (extended-spectrum β-lactamases), GFR (glomerular filtration rate), GNB (Gram-negative bacilli), IQR (interquartile ranges), LTCF (long-term care facility), K/DOQI (Kidney Disease Outcomes Quality Initiative), LR (likelihood ratios), MDR (multidrug-resistant), OR (odds ratio), ROC (receiver operating characteristic), SD (standard deviation)

      Keywords

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