A Clinical Decision Tree to Predict Whether a Bacteremic Patient Is Infected With an Extended-Spectrum β-Lactamase–Producing Organism

Goodman, Katherine E; Lessler, Justin; Cosgrove, Sara E.; Harris, Anthony D.; Lautenbach, Ebbing; Han, Jennifer H.; Milstone, Aaron M.; Massey, Colin J.; Tamma, Pranita D.

doi:10.1093/cid/ciw425

Cited by 153 publications

(104 citation statements)

References 31 publications

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“…This risk can be assessed based on several prediction models developed to help healthcare providers estimate the likelihood of infection with ESBL‐producing organisms using patient‐specific risk factors, like prior antibiotic exposure. Stratification of patients is crucial as the non‐stratified use of carbapenems is not justified and will only lead to further antimicrobial resistance . Piperacillin‐tazobactam is a possible choice but covers only 80% of the Enterobacteriaceae and 94% of the E. coli .…”

Section: Discussionmentioning

confidence: 99%

“…Stratification of patients is crucial as the non-stratified use of carbapenems is not justified and will only lead to further antimicrobial resistance. 20,21 Piperacillin-tazobactam is a possible choice but covers only 80% of the those who used aminoglycosides. 25 Aminoglycosides have been tried also for antibiotic prophylaxis.…”

Section: Timely Administration Of Adequate Empirical Antibiotics Whenmentioning

confidence: 99%

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Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single‐center experience

Shendi

Wallis

Painter

et al. 2018

Transplant Infectious Dis

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Urinary tract infection remains the commonest source of systemic infection among kidney transplant recipients and resistance to commonly used frontline antibiotics is common; thus, prevention and early detection are paramount. The appropriate choice of initial empirical antibiotic is vital to improve the outcome. Each unit needs to understand the epidemiology of organisms causing BSI in their transplant patients and their antibiotic susceptibilities.

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Section: Discussionmentioning

confidence: 99%

Section: Timely Administration Of Adequate Empirical Antibiotics Whenmentioning

confidence: 99%

Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single‐center experience

Shendi

Wallis

Painter

et al. 2018

Transplant Infectious Dis

View full text Add to dashboard Cite

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“…One of the global challenges that face mankind is the evolution of carbapenem-resistant enterobacteriaceae (CRE), as carbapenem antibiotics are considered a “last-resort” antibiotic [1,2]. With CRE blood infections, the mortality rate increases at about 8% for each hour of delay in obtaining a correct diagnosis and appropriate antibiotic treatment [3,4].…”

Section: Introductionmentioning

confidence: 99%

Rapid separation of bacteria from blood – Chemical aspects

Alizadeh

Wood

Buchanan

et al. 2017

Colloids and Surfaces B: Biointerfaces

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To rapidly diagnose infectious organisms causing blood sepsis, bacteria must be rapidly separated from blood, a very difficult process considering that concentrations of bacteria are many orders of magnitude lower than concentrations of blood cells. We have successfully separated bacteria from red and white blood cells using a sedimentation process in which the separation is driven by differences in density and size. Seven mL of whole human blood spiked with bacteria is placed in a 12-cm hollow disk and spun at 3000 rpm for 1 min. The red and white cells sediment more than 30-fold faster than bacteria, leaving much of the bacteria in the plasma. When the disk is slowly decelerated, the plasma flows to a collection site and the red and white cells are trapped in the disk. Analysis of the recovered plasma shows that about 36% of the bacteria is recovered in the plasma. The plasma is not perfectly clear of red blood cells, but about 94% have been removed. This paper describes the effects of various chemical aspects of this process, including the influence of anticoagulant chemistry on the separation efficiency and the use of wetting agents and platelet aggregators that may influence the bacterial recovery. In a clinical scenario, the recovered bacteria can be subsequently analyzed to determine their species and resistance to various antibiotics.

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“…Better prediction rules for infections caused by antibiotic-resistant pathogens are therefore needed. Prediction systems have been developed for Gram-negative bacteraemia in septic patients [24], carriage of or infection with ESBL-producing Enterobacteriaceae at hospital admission [1,25,26], and distinguishing bacteraemia with ESBL- or carbapenemase-producing pathogens from bacteraemia with susceptible Enterobacteriaceae [5–8].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, patients and physicians might benefit from prediction rules for 3GC-R EB. Although risk factors for carriage of ESBL-producing Enterobacteriaceae at hospital admission [1–4], and factors distinguishing ESBL- and carbapenemase-producing Enterobacteriaceae as a cause of bacteraemia have been determined [5–8], there are no prediction rules for identifying 3GC-R EB as a cause of bacteraemia at the time that empiric therapy must be started.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic prediction tools for bacteraemia caused by 3rd generation cephalosporin-resistant Enterobacteriaceae in suspected bacterial infections: a nested case-control study

Rottier

Werkhoven

et al. 2017

Preprint

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ObjectivesCurrent guidelines for empirical antibiotic treatment poorly predict the presence of 3rd generation cephalosporin resistant Enterobacteriaceae (3GC-R EB) as a cause of infection, thereby increasing unnecessary carbapenem use. We aimed to develop diagnostic scoring systems to better predict the presence of 3GC-R EB as a cause of bacteraemia.MethodsA retrospective nested case-control study was performed that included patients ≥18 years in whom blood cultures were obtained and intravenous antibiotics were initiated. Each patient with 3GC-R EB bacteraemia 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 described clinical risk factors at infection onset, selection strategies were used to derive scoring systems for the probability of community- and hospital-onset 3GC-R EB bacteraemia.Results3GC-R EB bacteraemia occurred in 90 of 22,506 (0.4%) community-onset and in 82 of 8,110 (1.0%) hospital-onset infections, and these cases were matched to 360 community-onset and 328 hospital-onset control episodes, respectively. The derived community-onset and hospital-onset scoring system consisted of 6 and 9 predictors, respectively, with c-statistics of 0.807 (95% confidence interval 0.756-0.855) and 0.842 (0.794-0.887). With selected score cutoffs, the models identified 3GC-R EB bacteraemia with equal sensitivity as existing guidelines, but reduced the proportion of patients classified as at risk for 3GC-R EB bacteraemia (i.e. eligible for empiric carbapenem therapy) with 40% in patients with community-onset and 49% in patients with hospital-onset infection.ConclusionsThese prediction rules for 3GC-R EB bacteraemia may reduce unnecessary empiric carbapenem use.

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A Clinical Decision Tree to Predict Whether a Bacteremic Patient Is Infected With an Extended-Spectrum β-Lactamase–Producing Organism

Abstract: Our findings suggest that a clinical decision tree can be used to estimate a bacteremic patient's likelihood of infection with ESBL-producing bacteria. Recursive partitioning offers a practical, user-friendly approach for addressing important diagnostic questions.

Cited by 153 publications

References 31 publications

Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single‐center experience

Epidemiology and impact of bloodstream infections among kidney transplant recipients: A retrospective single‐center experience

Rapid separation of bacteria from blood – Chemical aspects

Diagnostic prediction tools for bacteraemia caused by 3rd generation cephalosporin-resistant Enterobacteriaceae in suspected bacterial infections: a nested case-control study

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