Clinical Risk Score of Augustine et al for Predicting Extended-Spectrum beta-Lactamase Producing Enterobacteriaceae (ESBLE) in a Bloodstream Infection

Description

Augustine et al developed a clinical score for identifying a patient with a bloodstream infection caused by an extended-spectrum beta-lactamase producing Enterobacteriaceae. The score can help to identify a patient who may benefit from more aggressive management. The authors are from the University of South Carolina.

Patient selection: bloodstream infection (BSI) with monomicrobial isolate of an Enterobacteriaceae

Outcome: isolate of an ESBLE

Parameters:

(1) recent gastrointestinal or genitourinary procedure (within past 30 days)

(2) number of prior courses of beta-lactam or fluoroquinolone antibiotic (within period 3 to 90 days of bloodstream infection, with separate courses at least 3 days apart)

(3) history of infection or colonization with ESBLE in the past year

Parameter	Finding	Points
recent GI or GU proceedure	no	0
	yes	1
number of prior courses of selected antibiotics	0	0
	1	1
	2 or more	3
history of ESBLE	no	0
	yes	4

total score =

= SUM(points for all 3 parameters)

Interpretation:

• minimum score: 0

• maximum score: 8

• The higher the score the greater the risk.

Score	Percent ESBLE
0	< 1%
1	5%
2	11%
3	24%
4	44%
5	66%
6	83%
7 or 8	92%

Performance:

• A score >= 3 had a sensitvity of 43% and specificity of 97%.

• A score >=1 had a sensitivity of 88% and specificity of 77% (negative predictive value 99%).

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Clinical Risk Score of Augustine et al for Predicting Extended-Spectrum beta-Lactamase Producing Enterobacteriaceae (ESBLE) in a Bloodstream Infection

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