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

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RESEARCH PRODUCT

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

Micaela La Regina Elisabetta Garagiola Mauro Campanini Emanuela Foglia Marco Falcone Pierangelo Clerici Fabrizio Colombo Antonino Mazzone Corrao Salvatore Ercole Concia Francesco Dentali Giorgio Bonardi Alessio Farcomeni Maurizia Gambacorta Giusy Tiseo

subject

Male 0301 basic medicine Multivariate analysis Gram-negative bacilli Hospitalized patients Logistic regression Likelihood ratios in diagnostic testing Risk Factors Drug Resistance Multiple Bacterial Medicine Age Factor Multidrug-resistant Prospective Studies Multivariate Analysi Aged 80 and over Age Factors Anti-Bacterial Agents Hospitalization Italy Bloodstream infections; Gram-negative bacilli; Multidrug-resistant Bloodstream infections; Gram-negative bacilli; Multidrug-resistant; Internal Medicine Female Settore SECS-S/01 - Statistica Human medicine.medical_specialty Logistic Model 030106 microbiology Bloodstream infection 03 medical and health sciences Internal medicine Anti-Bacterial Agent Gram-Negative Bacteria Gram-Negative Bacterial Infection Internal Medicine Humans Aged business.industry Risk Factor Gram negative bacilli Odds ratio medicine.disease Prospective Studie Logistic Models ROC Curve Blood Culture Bacteremia Multivariate Analysis Etiology Bloodstream infections Gram-Negative Bacterial Infections business

description

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.

year	journal	country	edition	language
2018-01-01

10.1016/j.ejim.2018.01.029 http://hdl.handle.net/2108/222189