Identifying Patients Harboring Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae on Hospital Admission: Derivation and Validation of a Scoring System

Tumbarello, Mario; Trecarichi, Enrico Maria; Bassetti, Matteo; Rosa, Francesco Giuseppe De; Spanu, Teresa; Meco, Eugenia Di; Losito, Angela Raffaella; Parisini, Andrea; Pagani, Nicole; Cauda, Roberto

doi:10.1128/aac.00009-11

Cited by 150 publications

(153 citation statements)

References 35 publications

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“…In addition, stratification of patients with Gram-negative BSI based on prognosis as predicted by BSIMRS provides a tool to improve the use of empirical antimicrobial agents in patients with suspected BSI due to Gram-negative bacilli that harbor antimicrobial resistance genes. Prior studies have identified patients at risk of BSI due to Pseudomonas aeruginosa and fluoroquinolone-resistant and ESBL-producing Enterobacteriaceae based on the number of individual risk factors for antimicrobial resistance or the summation of the weighted score for each risk factor (17)(18)(19)(20). The decision to expand antimicrobial coverage may appear less complex in patients with no or multiple risk factors for antimicrobial resistance.…”

Section: Discussionmentioning

confidence: 99%

Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis

Cain

Kohn

Bookstaver

et al. 2015

Antimicrob Agents Chemother

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dThe bloodstream infection mortality risk score (BSIMRS) predicts the outcome of patients with Gram-negative bloodstream infections (BSI) with high discrimination. This retrospective cohort study examined the impact of inappropriate antimicrobial therapy on mortality in adult patients with Gram-negative BSI admitted to Palmetto Health Hospitals in Columbia, SC, USA, from 1 January 2011 to 31 December 2012 after stratification by predicted prognosis at initial presentation using BSIMRS. A multivariate Cox regression model was used to identify independent risk factors for 28-day mortality overall and within each predefined BSIMRS category (<5, 5 to 9, and >10). Relative risk reduction (RRR), absolute risk reduction (ARR), and number needed to treat (NNT) were calculated from a predictive logistic regression model of mortality. Overall, 390 unique patients with first episodes of Gram-negative BSI were identified. The median age was 66 years, and 229 (59%) were women. There was significant association between inappropriate antimicrobial therapy and mortality in patients with BSIMRS of 5 to 9 (adjusted hazard ratio

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Section: Discussionmentioning

confidence: 99%

Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis

Cain

Kohn

Bookstaver

et al. 2015

Antimicrob Agents Chemother

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“…MRSA, Clostridium difficile, ESBL-producing and fluoroquinolone-resistant Enterobacteriaceae. 6,21,[48][49][50][51][52] Other risk factors for infection with resistant bacteria are listed in Table 2. 6,9,[18][19][20][21][22]26,31,35,[37][38][39][40][41][42][43]51,53,54 In addition, and, independently of the risk of bacterial resistance, the patient's clinical presentation may also predict a severe clinical course or further deterioration.…”

Section: Importance Of Appropriate Initial Antibiotic Therapy In Febrmentioning

confidence: 99%

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

et al. 2013

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Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4 th European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'deescalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance. ABSTRACT© F e r r a t a S t o r t i F o u n d a t i o n 2 0 1 3 increasing resistance. The draft of these guidelines was discussed by the Expert Group at the ECIL-4 meeting in September 2011 and considers: i) bacterial epidemiology in neutropenic patients; ii) risk factors for resistance; iii) escalation and deescalation approaches; iv) the appropriate duration of empirical therapy; iv) non-conventional therapies against multi-resistant pathogens; and v) other issues on the management of bacterial infections in these patients. Up-dated slide sets from ECIL-4 covering these aspects are available on the websites of the four organizations involved in ECIL: the European Group for Blood and Marrow Transplantation, the European Organisation for Research and Treatment of Cancer, the Immunocompromised Host Society (ECIL), and the European Leukaemia Net. 12,13 This article summarizes the main ECIL recommendations on the initial empirical therapy of bacterial infections, but will also be valuable for the management of the many nonneutropenic but severely-immunosuppressed hematology patients. MethodsThe methodology of the ECIL conferences has been described previously. 11A working group of experts in the field of infectious diseases, microbiology or hematology was constituted, and reviewed the published literature in order to prepare proposals covering the following aspects: 1) empirical antibiotic therapy for...

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“…La última identificó como factores de riesgo a las variables de hospitalización reciente (< 12 meses), índice de Charlson, uso reciente de antimicrobiano (≤ 3 meses, β-lactámicos o fluroquinolonas), cateterización urinaria reciente y edad (≥ 70 años) 28 . Sus hallazgos son muy similares a los del presente estudio.…”

Section: Artículo Originalunclassified

Factores asociados a infecciones urinarias producidas por enterobacterias productoras de β-lactamasas de espectro extendido: una cohorte prospectiva

Avilés

Betancour

Velasco

et al. 2016

Rev. chil. infectol.

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Identifying Patients Harboring Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae on Hospital Admission: Derivation and Validation of a Scoring System

Cited by 150 publications

References 35 publications

Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis

Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

Factores asociados a infecciones urinarias producidas por enterobacterias productoras de β-lactamasas de espectro extendido: una cohorte prospectiva

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Identifying Patients Harboring Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae on Hospital Admission: Derivation and Validation of a Scoring System

Cited by 150 publications

References 35 publications

Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis

Stratification of the Impact of Inappropriate Empirical Antimicrobial Therapy for Gram-Negative Bloodstream Infections by Predicted Prognosis

European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia

Factores asociados a infecciones urinarias producidas por enterobacterias productoras de &#946;-lactamasas de espectro extendido: una cohorte prospectiva

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Factores asociados a infecciones urinarias producidas por enterobacterias productoras de β-lactamasas de espectro extendido: una cohorte prospectiva