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Table 1 Univariable analyses and multivariable model of carbapenem-resistant Enterobacrteriaceae (CRE) bloodstream infections (BSI) compared to extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL) BSI: adjusted associations and final score values

From: Simple bedside score to optimize the time and the decision to initiate appropriate therapy for carbapenem-resistant Enterobacteriaceae

 

Derivation Cohort (AHMC)

Validation Cohort (DMC)

Variable

ESBL, N (%) (N = 285)

CRE, N (%) (N = 58)

OR (95 % CI); p-value

AOR a (95 % C.I.); p-value

Score

ESBL, N (%) (N = 166)

CRE, N (%) (N = 16)

Male gender

169 (59)

29 (50)

0.69 (0.39, 1.21); 0.19

  

91 (55)

7 (44)

Age <65 years

47 (17)

16 (28)

1.9 (1.00, 3.71) 0.05

1.8 (0.81, 3.92); 0.16

6

78 (47)

5 (31)

LTCF residencyb

107 (38)

14 (25)

0.53 (0.28, 1.02); 0.06

  

96 (58)

13 (81)

Recent (3 months) hospitalization or LTCF stay

241 (85)

45 (78)

0.63 (0.32, 1.27); 0.20

  

100 (60)

14 (88)

Chronic hemodialysis

15 (5)

4 (7)

1.17 (0.40, 3.40); 0.78

  

33 (20)

5 (31)

Deteriorated functional status at admission

223 (79)

37 (67)

0.56 (0.30, 1.06); 0.07

  

105 (63)

14 (88)

Congestive heart failure

86 (31)

15 (26)

0.80 (0.42, 1.51); 0.48

  

63 (38)

8 (50)

Diabetes mellitus

115 (40)

22 (38)

0.90 (0.51, 1.61); 0.73

  

86 (52)

13 (81)

Chronic renal failurec

97 (34)

15 (26)

0.66 (0.35, 1.25); 0.21

  

68 (41)

10 (63)

No PVDd

218 (77)

50 (86)

1.8 (0.83, 4.07); 0.14

2.7 (1.06, 7.02); 0.04

10

134 (81)

13 (81)

Any neurological disease (including past cerebral events)

157 (55)

27 (47)

0.7 (0.4, 1.3; 0.2

  

68 (41)

12 (75)

Past or present (active) malignancy

62 (22)

14 (25)

1.2 (0.6, 2.2; 0.7

  

32 (19)

2 (13)

Hemiplegia or paraplegia

49 (17)

12 (21)

1.27 (0.63, 2.58); 0.50

  

25 (15)

7 (44)

Chemotherapy in the past 3 months

7 (2)

6 (10)

4.53 (1.46, 14.0); 0.009

6.8 (1.9–24.7); 0.003

19

5 (3)

1 (6)

Immunosuppressione

51 (18)

17 (29)

1.88 (0.99, 3.57); 0.05

  

28 (17)

5 (31)

Any use of antibiotics in the preceding 3 months

214 (77)

52 (90)

2.6 (1.1, 6.4); 0.03

  

112 (68)

14 (88)

Recent (6 months) invasive proceduref

120 (43)

33 (59)

1.9 (1.1, 3.4); 0.03

  

12 (86)

15 (100)

Intensive care unit stay at infection onset

151 (53)

39 (67)

1.82 (1.00, 3.30); 0.05

  

67 (40)

10 (63)

Permanent foreign invasive devicesg

145 (52)

44 (77)

3.17 (1.64, 6.15); 0.001

2.5 (1.2–5.2); 0.02

10

115 (70)

13 (81)

Reduced consciousness and/or cognition at time of acute illness

151 (53)

40 (73)

2.33 (1.23, 4.41); 0.009

2.5 (1.1–5.6); 0.02

9

100 (60)

13 (81)

Severe sepsis / septic shock / multiorgan failure at culture date

133 (48)

36 (66)

2.1 (1.1, 3.8); 0.02

  

43 (26)

4 (29)

Length of hospital stay at BSIh onset >3 days

134 (47)

44 (76)

2.85 (1.49, 5.43); 0.001

1.9 (0.9–4); 0.08

7

61 (37)

11 (73)

  1. a AOR adjusted odds ratio. bLong-term care facility. cSerum creatinine > 1.5 mg% at baseline. dPeripheral Vascular Disease. eImmunosuppression include any one of the following conditions at illness onset: neutropenia (<500 cells/mm3), glucocorticoid / steroid use in the past month, chemotherapy in the past 3 months, radiotherapy in the past 3 months, HIV, bone marrow or solid organ transplantation, or anti-TNF-α therapy in past 3 months (e.g. infliximab, adalimumab, certolizumab pegol, golimumab, etanercept). fInclude any type of surgery, endoscopy, percutaneous intervention. gAn invasive foreign device that was in place at least 48 h prior to ESBL or CRE isolation. Examples: tracheotomy, any feeding tubes, tunneled central lines, silicon-based urinary catheters, orthopedic external fixators, implanted defibrillator, pacemaker, and drains of any sort. Prosthetic heart valve or internal prosthetic joints were not considered a permanent foreign invasive devise. hbloodstream infection.
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Annals of Clinical Microbiology and Antimicrobials

ISSN: 1476-0711

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