Clinical Decision Tree of Goodman et al for Bacteremia Caused By an Extended Spectrum Beta-Lactamase (ESBL) Producing Bacteria

Description

Goodman et al developed a model for identifying a bacteremic patient with an isolate that could be an extended-spectrum beta-lactamase (ESBL) producing organism. This can help to identify a pateint who should be placed in isolation or receive appropriate antibiotics. The authors are from the Johns Hopkins University, the University of Maryland and the University of Pennsylvania.

Patient selection: age >= 18 years, bacteremia, E.coli or Klebsiella species, ceftriaxone MIC >= 2 µg/mL

Outcome: identification of ESBL isolate

Parameters used in a CART (classification and regression tree) analysis:

(1) history of ESBL colonization or infection in the past 6 months

(2) hospitalized >= 1 night in an ESBL high-burden region in previous 6 months (Latin America other than Caribbean, Middle East, South Asia, China, Mediterranean)

(3) antibiotic therapy for >= 6 days in past 6 months

(4) chronic indwelling vascular hardware present at bacteremia onset

(5) age of patient >= 43 years

History ESBL	Hospital	Antibiotic Therapy	Vascular Hardware	Age	Percent ESBL Positive
no	no	NA	NA	NA	7%
no	yes	no	NA	NA	37%
no	yes	yes	NA	NA	100%
yes	NA	NA	no	no	25%
yes	NA	NA	no	yes	81%
yes	NA	NA	yes	NA	92%

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Clinical Decision Tree of Goodman et al for Bacteremia Caused By an Extended Spectrum Beta-Lactamase (ESBL) Producing Bacteria

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