Pfaller and Segreti listed risk factors that can be used to identify a patient who may be harboring bacteria producing an extended-spectrum beta lactamase. A patient with one or more risk factors would be a candidate for closer monitoring and more aggressive management, especially if there was an unexplained failure in therapy with a beta-lactam antibiotic. The authors are from the University of Iowa in Iowa City and Rush Medical College in Chicago.
Antibiotic exposure-related risk factors:
(1) therapy with a third-generation cephalosporin
(2) therapy with trimethoprim-sulfamethoxazole
(3) therapy with ciprofloxacin
(4) total antibiotic exposure high
(5) delay in appropriate antibiotic therapy (failure to treat or inappropriate therapy)
Facility-related risk factors:
(1) prolonged hospital stay
(2) residence in a long-term care facility
(3) prolonged stay in an intensive care unit (adult or neonatal)
Condition-related risk factors:
(1) decubitus ulcer
(2) total dependence in activities of daily living
(3) severe illness
Management-related risk factors:
(1) indwelling catheter
(2) nasogastric or gastrostomy tube
(3) tracheostomy or endotracheal tube
where:
• All 3 items in condition-related reflect need for prolonged hospitalization or care.
An additional item not given in the original reference is a high rate of extended spectrum beta-lactamase in the environment.
