An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales

[Background] The possibility of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacterales (3GC-R-BSI) leads to a trade-off between empiric inappropriate treatment (IAT) and unnecessary carbapenem use (UCU). Accurately predicting 3GC-R-BSI could reduce IAT and UCU. We...

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Autores: Deelen, J. W. Timotëus, Rottier, Wouter C., Girón-Ortega, José A., Rodríguez-Baño, Jesús, Harbarth, Stephan, Tacconelli, Evelina, Jacobsson, Gunnar, Zahar, Jean Ralph, van Werkhoven, C. H., Bonten, Marc J. M., ESBL-PREDICT Study Team
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2021
País:España
Institución:Consejo Superior de Investigaciones Científicas (CSIC)
Repositorio:DIGITAL.CSIC. Repositorio Institucional del CSIC
OAI Identifier:oai:digital.csic.es:10261/269170
Acceso en línea:http://hdl.handle.net/10261/269170
Access Level:acceso abierto
Palabra clave:Antibiotic resistance
ESBL
Antibiotics
Bloodstream infections
Bacteraemia
ddc:616
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oai_identifier_str oai:digital.csic.es:10261/269170
network_acronym_str ES
network_name_str España
repository_id_str
spelling An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant EnterobacteralesDeelen, J. W. TimotëusRottier, Wouter C.Girón-Ortega, José A.Rodríguez-Baño, JesúsHarbarth, StephanTacconelli, EvelinaJacobsson, GunnarZahar, Jean Ralphvan Werkhoven, C. H.Bonten, Marc J. M.ESBL-PREDICT Study TeamAntibiotic resistanceESBLAntibioticsBloodstream infectionsBacteraemiaddc:616[Background] The possibility of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacterales (3GC-R-BSI) leads to a trade-off between empiric inappropriate treatment (IAT) and unnecessary carbapenem use (UCU). Accurately predicting 3GC-R-BSI could reduce IAT and UCU. We externally validate 2 previously derived prediction rules for community-onset (CO) and hospital-onset (HO) suspected bloodstream infections.[Methods] In 33 hospitals in 13 countries we prospectively enrolled 200 patients per hospital in whom blood cultures were obtained and intravenous antibiotics with coverage for Enterobacterales were empirically started. Cases were defined as 3GC-R-BSI or 3GC-R gram-negative infection (3GC-R-GNI) (analysis 2); all other outcomes served as a comparator. Model discrimination and calibration were assessed. Impact on carbapenem use was assessed at several cutoff points.[Results] 4650 CO infection episodes were included and the prevalence of 3GC-R-BSI was 2.1% (n = 97). IAT occurred in 69 of 97 (71.1%) 3GC-R-BSI and UCU in 398 of 4553 non–3GC-R-BSI patients (8.7%). Model calibration was good, and the AUC was .79 (95% CI, .75–.83) for 3GC-R-BSI. The prediction rule potentially reduced IAT to 62% (60/97) while keeping UCU comparable at 8.4% or could reduce UCU to 6.3% (287/4553) while keeping IAT equal. IAT and UCU in all 3GC-R-GNIs (analysis 2) improved at similar percentages. 1683 HO infection episodes were included and the prevalence of 3GC-R-BSI was 4.9% (n = 83). Here model calibration was insufficient.[Conclusions] A prediction rule for CO 3GC-R infection was validated in an international cohort and could improve empirical antibiotic use. Validation of the HO rule yielded suboptimal performance.J. R.-B. receives funds for research from Plan Nacional de I+D+i 2013–2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0001), co-financed by the European Development Regional Fund “A Way to Achieve Europe,” Operative Program Intelligent Growth 2014-2020.Peer reviewedOxford University PressInstituto de Salud Carlos IIIMinisterio de Ciencia, Innovación y Universidades (España)Red Española de Investigación en Patología InfecciosaEuropean CommissionConsejo Superior de Investigaciones Científicas [https://ror.org/02gfc7t72]2022202220212022info:eu-repo/semantics/articlehttp://purl.org/coar/resource_type/c_6501Publisher's versioninfo:eu-repo/semantics/publishedVersionhttp://hdl.handle.net/10261/269170reponame:DIGITAL.CSIC. Repositorio Institucional del CSICinstname:Consejo Superior de Investigaciones Científicas (CSIC)Ingléshttp://dx.doi.org/10.1093/cid/ciaa950Síinfo:eu-repo/semantics/openAccessoai:digital.csic.es:10261/2691702026-05-22T06:33:51Z
dc.title.none.fl_str_mv An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
title An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
spellingShingle An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
Deelen, J. W. Timotëus
Antibiotic resistance
ESBL
Antibiotics
Bloodstream infections
Bacteraemia
ddc:616
title_short An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
title_full An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
title_fullStr An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
title_full_unstemmed An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
title_sort An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales
dc.creator.none.fl_str_mv Deelen, J. W. Timotëus
Rottier, Wouter C.
Girón-Ortega, José A.
Rodríguez-Baño, Jesús
Harbarth, Stephan
Tacconelli, Evelina
Jacobsson, Gunnar
Zahar, Jean Ralph
van Werkhoven, C. H.
Bonten, Marc J. M.
ESBL-PREDICT Study Team
author Deelen, J. W. Timotëus
author_facet Deelen, J. W. Timotëus
Rottier, Wouter C.
Girón-Ortega, José A.
Rodríguez-Baño, Jesús
Harbarth, Stephan
Tacconelli, Evelina
Jacobsson, Gunnar
Zahar, Jean Ralph
van Werkhoven, C. H.
Bonten, Marc J. M.
ESBL-PREDICT Study Team
author_role author
author2 Rottier, Wouter C.
Girón-Ortega, José A.
Rodríguez-Baño, Jesús
Harbarth, Stephan
Tacconelli, Evelina
Jacobsson, Gunnar
Zahar, Jean Ralph
van Werkhoven, C. H.
Bonten, Marc J. M.
ESBL-PREDICT Study Team
author2_role author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Instituto de Salud Carlos III
Ministerio de Ciencia, Innovación y Universidades (España)
Red Española de Investigación en Patología Infecciosa
European Commission
Consejo Superior de Investigaciones Científicas [https://ror.org/02gfc7t72]
dc.subject.none.fl_str_mv Antibiotic resistance
ESBL
Antibiotics
Bloodstream infections
Bacteraemia
ddc:616
topic Antibiotic resistance
ESBL
Antibiotics
Bloodstream infections
Bacteraemia
ddc:616
description [Background] The possibility of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacterales (3GC-R-BSI) leads to a trade-off between empiric inappropriate treatment (IAT) and unnecessary carbapenem use (UCU). Accurately predicting 3GC-R-BSI could reduce IAT and UCU. We externally validate 2 previously derived prediction rules for community-onset (CO) and hospital-onset (HO) suspected bloodstream infections.
publishDate 2021
dc.date.none.fl_str_mv 2021
2022
2022
2022
dc.type.none.fl_str_mv info:eu-repo/semantics/article
http://purl.org/coar/resource_type/c_6501
Publisher's version
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10261/269170
url http://hdl.handle.net/10261/269170
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv http://dx.doi.org/10.1093/cid/ciaa950
Sí
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv Oxford University Press
publisher.none.fl_str_mv Oxford University Press
dc.source.none.fl_str_mv reponame:DIGITAL.CSIC. Repositorio Institucional del CSIC
instname:Consejo Superior de Investigaciones Científicas (CSIC)
instname_str Consejo Superior de Investigaciones Científicas (CSIC)
reponame_str DIGITAL.CSIC. Repositorio Institucional del CSIC
collection DIGITAL.CSIC. Repositorio Institucional del CSIC
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.812429

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