Gavaghan Victoria, Miller Jessica L, Shields Maureen, Dela-Pena Jennifer
Department of Pharmacy, Advocate Lutheran General Hospital, 1775 Dempster Street, Park Ridge, IL 60068, USA.
Advocate Aurora Research Institute, 945 N 12 Street, Milwaukee, WI 53233, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Apr 24;5(1):e102. doi: 10.1017/ash.2025.70. eCollection 2025.
To identify institution-specific risk factors for extended-spectrum beta-lactamase (ESBL) bloodstream infections (BSI) to develop and validate a risk assessment scoring tool that can be utilized for hospitalized patients.
Single-center, retrospective, case-control study.
Tertiary teaching hospital.
Hospitalized adult and pediatric patients with or spp. BSI were stratified based on ESBL production between August 2019 to July 2021. Exclusion criteria included patients < 28 days old, a positive blood culture resulting prior to admission/after discharge or a polymicrobial and/or carbapenem-resistant BSI.
Multivariable logistic regression assessed predictors of ESBL in a derivation cohort. Predictors were applied to a novel validation BSI cohort using area under the receiver-operator characteristics curve (ROC AUC) to assess the reliability of identifying patients likely to harbor ESBL at the time of organism identification.
A total of 238 patients in the derivation cohort met inclusion criteria stratified as ESBL (n = 68) or non-ESBL (n = 170). Multivariable logistic regression demonstrated diabetes, 30-day history of invasive procedure or antibiotic use, and/or history of ESBL as independent predictors of ESBL. After creation of an ESBL risk assessment tool, the results were applied to a validation cohort of 170 patients. This model displayed good calibration and discrimination with a strong predictive power (Hosmer-Lemeshow χ= 4.66, p = 0.19; ROC AUC = 0.88, 95% CI = 0.7909 - 0.974).
A validated ESBL risk assessment tool reliably identified hospitalized patients likely to harbor ESBL or spp. BSI upon organism identification.
确定特定机构中广谱β-内酰胺酶（ESBL）血流感染（BSI）的危险因素，以开发并验证一种可用于住院患者的风险评估评分工具。
单中心、回顾性病例对照研究。
三级教学医院。
2019年8月至2021年7月期间，因大肠埃希菌或肺炎克雷伯菌BSI住院的成年和儿科患者，根据ESBL产生情况进行分层。排除标准包括年龄<28天的患者、入院前/出院后血培养阳性或多重微生物和/或耐碳青霉烯类BSI患者。
多变量逻辑回归分析在一个推导队列中评估ESBL的预测因素。将预测因素应用于一个新的验证性BSI队列，使用受试者操作特征曲线下面积（ROC AUC）来评估在病原体鉴定时识别可能携带ESBL患者的可靠性。
推导队列中的238例患者符合纳入标准，分为ESBL组（n = 68）和非ESBL组（n = 170）。多变量逻辑回归分析显示，糖尿病、侵入性操作或抗生素使用的30天病史以及ESBL病史是ESBL的独立预测因素。创建ESBL风险评估工具后，将结果应用于170例患者的验证队列。该模型显示出良好的校准和区分能力，具有很强的预测能力（Hosmer-Lemeshow χ= 4.66，p = 0.19；ROC AUC = 0.88，95% CI = 0.7909 - 0.974）。
一种经过验证的ESBL风险评估工具能够可靠地识别在病原体鉴定时可能携带ESBL大肠埃希菌或肺炎克雷伯菌BSI的住院患者。
