Development of diagnostic prediction tools for bacteraemia caused by third-generation cephalosporin-resistant enterobacteria in suspected bacterial infections: a nested case–control study

Rottier, W.C.; van Werkhoven, C.H.; Bamberg, Y.R.P.; Dorigo-Zetsma, J.W.; van de Garde, E.M.; van Hees, B.C.; Kluytmans, J.A.J.W.; Kuck, E.M.; van der Linden, P.D.; Prins, J.M.; Thijsen, S.F.T.; Verbon, A.; Vlaminckx, B.J.M.; Ammerlaan, H.S.M.; Bonten, M.J.M.

doi:10.1016/j.cmi.2018.03.023

Cited by 22Antibiotic Resistance in BacteriaAntibiotic Use and ResistanceBacterial Identification and Susceptibility Testing

Development of diagnostic prediction tools for bacteraemia caused by third-generation cephalosporin-resistant enterobacteria in suspected bacterial infections: a nested case–control study

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Rottier, W.C., van Werkhoven, C.H., Bamberg, Y.R.P., Dorigo-Zetsma, J.W., van de Garde, E.M., van Hees, B.C., Kluytmans, J.A.J.W., Kuck, E.M. +7 more·2018·Clinical Microbiology and Infection

DOI 10.1016/j.cmi.2018.03.023

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Abstract

Objectives Current guidelines for the empirical antibiotic treatment predict the presence of third-generation cephalosporin-resistant enterobacterial bacteraemia (3GCR-E-Bac) in case of infection only poorly, thereby increasing unnecessary carbapenem use. We aimed to develop diagnostic scoring systems which can better predict the presence of 3GCR-E-Bac.Methods A retrospective nested case-control study was performed that included patients ≥18 years of age from eight Dutch hospitals in whom blood cultures were obtained and intravenous antibiotics were initiated. Each patient with 3GCR-E-Bac 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 commonly described clinical risk factors at infection onset, selection strategies were used to derive scoring systems for the probability of community- and hospital-onset 3GCR-E-Bac.Results 3GCR-E-Bac occurred in 90 of 22 506 (0.4%) community-onset infections and in 82 of 8110 (1.0%) hospital-onset infections, and these cases were matched to 360 community-onset and 328 hospital-onset control episodes. The derived community-onset and hospital-onset scoring systems consisted of six and nine predictors, respectively. With selected score cut-offs, the models identified 3GCR-E-Bac with sensitivity equal to existing guidelines (community-onset: 54.3%; hospital-onset: 81.5%). However, they reduced the proportion of patients classified as at risk for 3GCR-E-Bac (i.e. eligible for empirical carbapenem therapy) with 40% (95%CI 21-56%) and 49% (95%CI 39-58%) in, respectively, community-onset and hospital-onset infections.Conclusions These prediction scores for 3GCR-E-Bac, specifically geared towards the initiation of empirical antibiotic treatment, may improve the balance between inappropriate antibiotics and carbapenem overuse.

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Factors guiding double gram-negative coverage include proven infection or colonisation with resistant organisms in the prior year, local prevalence, hospital-acquired/healthcare-associated infection, broad-spectrum antibiotics in prior 90 days, concurrent SDD, travel to a highly endemic country in prior 90 days, and hospitalisation abroad in prior 90 days.
“Factors to guide this decision include: proven infection or colonisation with antibiotic-resistant organisms within the preceding year, local prevalence of antibiotic-resistant organisms, hospital-acquired/healthcare associated (versus community-acquired infection), broad-spectrum antibiotic use within the preceding 90 days”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [164]

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The CREPE Score: A Predictive Tool for Third-Generation Cephalosporin-Resistant Enterobacterales Pneumonia in Community Settings
Khunkitti, K., Sribenjalux, W., Kuwatjanakul, W., Arunsurat, I., So-ngern, A., & Meesing, A. (2023) · Infection and Drug Resistance · doi:10.2147/idr.s417863
Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales
Moghnieh, R., Abdallah, D., Jadayel, M., Zorkot, W., Masri, H. E., Dib, M., Omar, T., Sinno, L., Lakkis, R., & Jisr, T. (2021) · Scientific Reports · doi:10.1038/s41598-021-94295-1 · Cited by 31 · see citing works
An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
Deelen, J. W. T., Rottier, W. C., Girón-Ortega, J. A., Rodríguez‐Baño, J., Harbarth, S., Tacconelli, E., Jacobsson, G., Zahar, J., van Werkhoven, C. H., Bonten, M. J. M., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa950 · Cited by 4 · see citing works
Self-citation

Authors: Rottier, W. C., van Werkhoven, C. H., Bamberg, Y. R. P., Dorigo-Zetsma, J. W., van de Garde, E. M., van Hees, B. C., Kluytmans, J. A. J. W., Kuck, E. M., van der Linden, P. D., Prins, J. M., Thijsen, S. F. T., Verbon, A., Vlaminckx, B. J. M., Ammerlaan, H. S. M., & Bonten, M. J. M.
Affiliations: University Medical Center Utrecht (NL)
Tergooi (NL)
Diakonessenhuis hospital (NL)
Amsterdam UMC Location University of Amsterdam (NL)
Erasmus MC (NL)
St. Antonius Ziekenhuis (NL)
Corresponding author: Rottier, W.C.
ORCID: Rottier, W.C.
Kluytmans, J.A.J.W.
Kuck, E.M.
Prins, J.M.
Thijsen, S.F.T.
Verbon, A.
Vlaminckx, B.J.M.
Ammerlaan, H.S.M.
Bonten, M.J.M.
Venue: Clinical Microbiology and Infection
Publisher: Elsevier BV
Published: 2018-12
Volume: 24
Issue: 12
Pages: 1315-1321
ISSN: 1198-743X (ISSN-L)
DOI: 10.1016/j.cmi.2018.03.023
OpenAlex: W2887873765
Cited by: 22
References: 44
Citations by year: 2026: 1 · 2025: 1 · 2024: 3 · 2023: 3 · 2022: 1 · 2021: 4 · 2020: 1 · 2019: 5 · 2018: 3
FWCI: 1.23
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 365 d)
Locations: Clinical Microbiology and Infection (publishedVersion)
bioRxiv (Cold Spring Harbor Laboratory) (acceptedVersion, cc-by-nc)
PubMed (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
Data Archiving and Networked Services (DANS) (submittedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
Pure Amsterdam UMC (submittedVersion)
Funders: The Netherlands Organization for Health Research and Development (205200007)
Topics: Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Bacterial Identification and Susceptibility Testing
Keywords: bacteremia, third-generation cephalosporin resistance, Enterobacteriaceae, empirical antibiotic therapy, community-onset infection, hospital-onset infection, clinical risk factors, blood culture, inappropriate antibiotic use
MeSH terms: Aged, Anti-Bacterial Agents, Cephalosporins, Cross Infection, Enterobacteriaceae, Enterobacteriaceae Infections, Female, Humans, Male, Microbial Sensitivity Tests, Middle Aged, Retrospective Studies, Risk Factors, Case-Control Studies, Bacteremia

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Development of diagnostic prediction tools for bacteraemia caused by third-generation cephalosporin-resistant enterobacteria in suspected bacterial infections: a nested case–control study

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