Clinical Prediction Score for Community-Onset Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella Species

Abstract

Background This study aimed to identify the predictors and build a prediction score for community-onset bloodstream infections (CO-BSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species. Methods All CO-BSIs caused by E. coli and Klebsiella species from 2012 to 2015 were grouped into derivation (BSIs from 2012 to 2014) and validation (BSIs in 2015) cohorts. A prediction score was built using the coefficients of the multivariate logistic regression model from the derivation cohort. Results The study included 886 CO-BSIs (594 and 292 in the derivation and validation cohorts, respectively). The independent predictors of CO-BSIs caused by ESBL-producing E. coli and Klebsiella species included: 1) identification of ESBL-producing microorganisms from any clinical culture within one year of admission, 2) beta-lactam or fluoroquinolone treatment within 30 days (with 2 or more courses within 90 days; with 1 course within 90 days), 3) hospitalization within one year, 4) the presence of an indwelling urinary catheter at the time of admission. The area under the curve (AUC) of the clinical prediction score was 0.72 (95% confidence interval [CI], 0.68–0.77). In the validation cohort, the AUC was 0.70 (95% CI, 0.63–0.77). Conclusions The results of this study suggest a simple and easy-to-use scoring system to predict CO-BSIs caused by ESBL-producing E. coli and Klebsiella species.

Comparison of antimicrobial resistances and clinical features in community-onset Escherichia coli and Klebsiella pneumoniae bacteremia

“…The resistance rates of E. coli and K. pneumoniae to 3GCs and FQs were much higher in the Korean Anti-microbial Resistance Monitoring System (KARMS) from 2013 to 2015 than in our study because KARMS data includes both nosocomial and community pathogens [ 7 ]. In a recent study of community-onset E. coli and Klebsiella species bacteremia from 2012 to 2015, 27.2% of E. coli and 14.9% of Klebsiella species were ESBL producers and the ciprofloxacin resistance rate was 38.7% in E. coli and 21.0% in Klebsiella species [ 2 ]; the resistant rates of 3GC and FQs were higher than reported in our studies, especially in the Klebsiella species , because the underlying comorbidities were more severe than those of our studies. Because Daegu Fatima Hospital is a secondary care community-based medical institution, we believe that our data reflects the antimicrobial resistance rates in community-onset infections, and therefore, 3GCs and FQs remain useful empirical options for community- onset infections caused by K. pneumoniae .…”

“…Nevertheless, our hospital is the largest secondary care medical institution in the Daegu area and we analyzed more than one thousand cases of E. coli and K. pneumoniae community-onset bacteremia. In our study, the proportion of patients with underlying comorbidities was lower than a community-onset bacteremia study conducted at a tertiary care hospital in Seoul [ 2 ]. Therefore, we believe that our data are more representative of community-onset infections than those of studies performed in a tertiary care hospital.…”

“…In that study, 3rd generation cephalosporin (3GC) and fluoroquinolone (FQ) resistance rates were 6.6% and 24.5% in E. coli and 4.9% and 4.9% in K. pneumoniae , respectively. A study of community-onset bacteremia in a tertiary hospital in Seoul, Korea between 2012 to 2015 showed that 27.2% of E. coli and 14.9% of Klebsiella species were extended spectrum β-lactam (ESBL) producers and 37.8% of E. coli and 21.0% of Klebsiella species had ciprofloxacin resistance [ 2 ]. The resistant rates to 3GC and FQ antimicrobials in Klebsiella species were consistently lower than in E. coli in both studies even though a recent study in a tertiary care hospital showed higher resistant rates.…”

Risk factors of community-onset extended-spectrum β-lactamase Escherichia coli and Klebsiella pneumoniae bacteraemia: an 11-year population-based case–control–control study in Denmark

“…Several studies have reported risk factors associated with ESBL production [4], but fewer studies have focused strictly on community-onset risk factors. The most consistent communityonset risk factors include previous use of (specific) antibiotics [5e13], recent hospitalization [5,7,8], health-care-associated infection [9,11,13], urological disease [6,8,9] and urinary catheter use [5,7,11]. Still, the majority of these studies have been from high prevalence areas, they were of limited size, and only one [6] was population-based.…”

A Clinical Prediction Tool for Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae Urinary Tract Infection

“…ESBL-PE hydrolysis of carbapenem antibiotics is low, so carbapenem antibiotics are often used as the rst choice in clinical treatment of ESBL-PE infections. However, the abuse of carbapenems may result in the selection of carbapenem resistant Enterobacteriaceae, which will ultimately make it more di cult to treat this kind of bacteria [3,4].…”