Predicting multidrug-resistant gram-negative bacterial colonization and associated infection on hospital admission
Journal
Infection Control and Hospital Epidemiology
Journal Volume
38
Journal Issue
10
Pages
1216-1225
Date Issued
2017
Author(s)
Yang, Bey-Jing
Chen, Shang-Yu
Huang, Ya-Huei
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. ? 2017 by The Society for Healthcare Epidemiology of America. All rights reserved.
Other Subjects
antibiotic agent; antiinfective agent; Acinetobacter baumannii; Acinetobacter lwoffii; age; aged; Article; bacterial colonization; cerebrovascular accident; chemotherapy; Chryseobacterium indologenes; Citrobacter; Citrobacter freundii; Citrobacter koseri; clinical assessment tool; cohort analysis; colonization prediction model; congestive heart failure; decubitus; diabetes mellitus; diagnostic test accuracy study; dialysis catheter; double lumen catheter; drug exposure; Elizabethkingia meningoseptica; emergency patient; emergency ward; end stage renal disease; Enterobacter; Enterobacter aerogenes; Enterobacter cloacae; Escherichia coli; female; Foley balloon catheter; gender; Gram negative infection; hemodialysis; Hickman catheter; high risk population; hospital admission; hospital discharge; hospitalization; human; implantable port system; infection risk; intensive care unit; Klebsiella pneumoniae; liver cirrhosis; major clinical study; male; malignant neoplasm; medical history; Morganella morganii; multidrug resistant gram negative bacterial infection; nursing home; patient care; peripherally inserted central venous catheter; predictive value; prospective study; Proteus mirabilis; Providencia stuartii; Pseudomonas aeruginosa; residential care; risk assessment; Serratia marcescens; validation study; adult; cross infection; drug effect; Gram negative bacterium; Gram negative infection; hospital emergency service; isolation and purification; microbiology; middle aged; multidrug resistance; procedures; randomization; receiver operating characteristic; risk factor; Taiwan; university hospital; very elderly; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cross Infection; Drug Resistance, Multiple, Bacterial; Emergency Service, Hospital; Female; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Hospitalization; Hospitals, University; Humans; Male; Middle Aged; Prospective Studies; Random Allocation; Risk Assessment; Risk Factors; ROC Curve; Taiwan
Type
journal article