Identification of hospitalized patients with community-acquired infection in whom treatment guidelines do not apply: a validated model

• Type: Article in International Scientific Journal
• Date: 2020

Authors

Cardoso, T (Author) Other; Pedro Pereira Rodrigues (Author) FMUP; Nunes, C (Author) Other; Almeida, M (Author) Other; Cancela, J (Author) Other; Rosa, F (Author) Other; Rocha Pereira, N (Author) FMUP; Ferreira, IS (Author) Other; Seabra Pereira, F (Author) Other; Vaz, P (Author) Other; Carneiro, L (Author) Other; Andrade, C (Author) Other; Davis, J (Author) Other; Marcal, A (Author) Other; Friedman, ND (Author) Other

Journal

Title: Journal of Antimicrobial Chemotherapy

Vol. 75

Pages: 1047-1053

ISSN: 0305-7453

Publisher: Oxford University Press

Indexing

ISI Web of Knowledge - 0 Citations

Scopus - 0 Citations

Other information

Authenticus ID: P-00R-WH4

DOI: 10.1093/jac/dkz521

Abstract (EN): Objectives: To develop and validate a clinical model to identify patients admitted to hospital with community-acquired infection (CAI) caused by pathogens resistant to antimicrobials recommended in current CAI treatment guidelines. Methods: International prospective cohort study of consecutive patients admitted with bacterial infection. Logistic regression was used to associate risk factors with infection by a resistant organism. The final model was validated in an independent cohort. Results: There were 527 patients in the derivation and 89 in the validation cohort. Independent risk factors identified were: atherosclerosis with functional impairment (Karnofsky index <70) [adjusted OR (aOR) (95% CI) = 2.19 (1.41-3.40)]; previous invasive procedures [adjusted OR (95% CI) = 1.98 (1.28-3.05)]; previous colonization with an MDR organism (MDRO) [aOR (95% CI) = 2.67 (1.48-4.81)]; and previous antimicrobial therapy [aOR (95% CI) = 2.81 (1.81-4.38)]. The area under the receiver operating characteristics (AU-ROC) curve (95% CI) for the final model was 0.75 (0.70-0.79). For a predicted probability >= 22% the sensitivity of the model was 82%, with a negative predictive value of 85%. In the validation cohort the sensitivity of the model was 96%. Using this model, unnecessary broad-spectrum therapy would be recommended in 30% of cases whereas undertreatment would occur in only 6% of cases. Conclusions: For patients hospitalized with CAI and none of the following risk factors: atherosclerosis with functional impairment; previous invasive procedures; antimicrobial therapy; or MDRO colonization, CAI guidelines can safely be applied. Whereas, for those with some of these risk factors, particularly if more than one, alternative antimicrobial regimens should be considered.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 7