Predictive Score for Carbapenem-Resistant Gram-Negative Bacilli Sepsis: Single-Center Prospective Cohort Study.
Marisa Zenaide Ribeiro GomesDouglas Quintanilha BragaDebora Otero Britto Passos PinheiroRenata Cristina Amorim Silveira VerducLetícia Vellozo Dos ReisElisangela Martins de LimaNewton Dias LourençoPatrícia Aquen CidDebora Souza BeckLuiz Henrique Zanata PinheiroJoão Pedro Silva TonháLuiza Silva de SousaMayra Lopes Secundo DiasAmanda Aparecida da Silva MachadoMurillo Marçal CastroVitoria Pinson Ruggi DutraLuciana Sênos de MelloMaxuel Cassiano da SilvaThaisa Medeiros TozoYann Rodrigues MathuiyLucas Lameirão Pinto de Abreu RosasPaulo Cesar Mendes BarrosJeane Oliveira da SilvaPriscila Pinho da SilvaCarolina Souza BandeiraScyla Maria de Sant Anna Reis Di Chiara SalgadoMarcio Zenaide de Oliveira AlvesRoberto Queiroz SantosJosé Aurélio MarquesCaio Augusto Santos RodriguesSaint Clair Dos Santos Gomes-Júniornull nullPublished in: Antibiotics (Basel, Switzerland) (2022)
A clinical-epidemiological score to predict CR-GNB sepsis to guide empirical antimicrobial therapy (EAT), using local data, persists as an unmet need. On the basis of a case-case-control design in a prospective cohort study, the predictive factors for CR-GNB sepsis were previously determined as prior infection, use of mechanical ventilation and carbapenem, and length of hospital stay. In this study, each factor was scored according to the logistic regression coefficients, and the ROC curve analysis determined its accuracy in predicting CR-GNB sepsis in the entire cohort. Among the total of 629 admissions followed by 7797 patient-days, 329 single or recurrent episodes of SIRS/sepsis were enrolled, from August 2015 to March 2017. At least one species of CR-GNB was identified as the etiology in 108 (33%) episodes, and 221 were classified as the control group. The cutoff point of ≥3 (maximum of 4) had the best sensitivity/specificity, while ≤1 showed excellent sensitivity to exclude CR-GNB sepsis. The area under the curve was 0.80 (95% CI: 0.76-0.85) and the number needed to treat was 2.0. The score may improve CR-GNB coverage and spare polymyxins with 22% (95% CI: 17-28%) adequacy rate change. The score has a good ability to predict CR-GNB sepsis and to guide EAT in the future.
Keyphrases
- intensive care unit
- septic shock
- acute kidney injury
- gram negative
- mechanical ventilation
- multidrug resistant
- healthcare
- emergency department
- case control
- staphylococcus aureus
- acute respiratory distress syndrome
- drug resistant
- escherichia coli
- acinetobacter baumannii
- case report
- machine learning
- electronic health record
- big data
- data analysis
- deep learning
- smoking cessation
- genetic diversity