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Predicting Multidrug-Resistant Gram-Negative Bacterial Colonization and Associated Infection on Hospital Admission

Published online by Cambridge University Press:  05 September 2017

Wen-Pin Tseng ,
Yee-Chun Chen ,
Bey-Jing Yang ,
Shang-Yu Chen ,
Jr-Jiun Lin ,
Ya-Huei Huang ,
Chia-Ming Fu ,
Shan-Chwen Chang  and
Shey-Ying Chen
Wen-Pin Tseng
Affiliation:
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Yee-Chun Chen
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan Center for Infection Control, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Bey-Jing Yang
Affiliation:
Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
Shang-Yu Chen
Affiliation:
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Jr-Jiun Lin
Affiliation:
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Ya-Huei Huang
Affiliation:
Center for Infection Control, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
Chia-Ming Fu
Affiliation:
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Shan-Chwen Chang
Affiliation:
Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
Shey-Ying Chen*
Affiliation:
Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
*
Address correspondence to Shey-Ying Chen, MD, Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University. No. 7, Zhongshan S Rd, Zhongzheng District, Taipei City 100, Taiwan (erdrcsy@ntu.edu.tw).
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Abstract

OBJECTIVE

Isolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care.

METHODS

A 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures.

RESULTS

A score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06–3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57–8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24–4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39–4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16–4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001).

CONCLUSION

A model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB.

Infect Control Hosp Epidemiol 2017;38:1216–1225

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 10 , October 2017 , pp. 1216 - 1225
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION: This study was presented in part at the 51st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Illinois, on September 19, 2011, and at the 7th Asian Conference on Emergency Medicine in Tokyo, Japan, on October 24, 2013.

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