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Utility of a Clinical Risk Factor Scoring Model in Predicting Infection with Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae on Hospital Admission

Published online by Cambridge University Press:  02 January 2015

Steven W. Johnson ,
Deverick J. Anderson ,
D. Byron May  and
Richard H. Drew
Steven W. Johnson*
Affiliation:
Duke University Hospital, Durham, North Carolina Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina
Deverick J. Anderson
Affiliation:
Duke University Hospital, Durham, North Carolina
D. Byron May
Affiliation:
Duke University Hospital, Durham, North Carolina Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina
Richard H. Drew
Affiliation:
Duke University Hospital, Durham, North Carolina Campbell University College of Pharmacy and Health Sciences, Buies Creek, North Carolina
*
Campbell University College of Pharmacy, and Health Sciences, 1612 Barndale Glen Court, Winston-Salem, NC 27106 ([email protected])
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Abstract

Objective.

To validate the utility of a previously published scoring model (Italian) to identify patients infected with community-onset extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-EKP) and develop a new model (Duke) based on local epidemiology.

Methods.

This case-control study included patients 18 years of age or more admitted to Duke University Hospital between January 1, 2008, and December 31, 2010, with culture-confirmed infection due to an ESBL-EKP (cases). Uninfected controls were matched to cases (3 : 1). The Italian model was applied to our patient population for validation. The Duke model was developed through logistic-regression-based prediction scores calculated on variables independently associated with ESBL-EKP isolation. Sensitivities and specificities at various point cutoffs were determined, and determination of the area under the receiver operating characteristic curve (ROC AUC) was performed.

Results.

A total of 123 cases and 375 controls were identified. Adjusted odds ratios and 95% confidence intervals for variables previously identified in the Italian model were as follows: hospitalization (3.20 [1.62–6.55]), transfer (4.31 [2.15–8.78]), urinary catheterization (5.92 [3.09–11.60]), β-lactam and/or fluoroquinolone therapy (3.76 [2.06–6.95]), age 70 years or more (1.55 [0.79–3.01]), and Charlson Comorbidity Score of 4 or above (1.06 [0.55–2.01]). Sensitivity and specificity were, respectively, more than or equal to 95% and less than or equal to 47% for scores 3 or below and were less than or equal to 50% and more than or equal to 96% for scores 8 or above. The ROC AUC was 0.88. Variables identified in the Duke model were as follows: hospitalization (2.63 [1.32–5.41]), transfer (5.30 [2.67–10.71]), urinary catheterization (6.89 [3.62–13.38]), β-lactam and/or fluoroquinolone therapy (3.47 [1.91–6.41]), and immunosuppression (2.34 [1.14–4.80]). Sensitivity and specificity were, respectively, more than or equal to 94% and less than or equal to 65% for scores 3 or below and were less than or equal to 58% and more than or equal to 95% for scores 8 or above. The ROC AUC was 0.89.

Conclusion.

While the previously reported model was an excellent predictor of community-onset ESBL-EKP infection, models utilizing factors based on local epidemiology may be associated with improved performance.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 4 , April 2013 , pp. 385 - 392
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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