Rottier et al reported 2 models for predicting bacteremia caused by a third-generation cephalosporin-resistant Enterobacteria that should be treated with a carbapenem. One model is for community-acquired infections and one for hospital-acquired. The authors are from multiple institutions in The Netherlands.
Patient selection: age >= 18 years of age with sepsis due to Enterobacteriaceae
Parameters:
(1) prior identification of a third generation resistant Enterobacteria during the past year
(2) suspected source of infection
(3) immunocompromised
(4) use of any antibiotics in the past 2 months
(5) age in years
Parameter
Finding
Beta Coefficient
Points
prior ID
no
0
0
yes
1.963
100
suspected source
UTI
1.081
50
lower respiratory tract
-0.896
-50
other
0
0
immuno-compromised
no
0
0
yes
0.491
25
antibiotic use
no
0
0
yes
0.314
25
age in years
0.018 * (age)
(age)
total score =
= SUM(points for all 5 parameters)
X =
= SUM(beta-coefficients) - 7.248
probability of resistant bacteria causing bacteremia =
= 1/(1 + EXP((-1) * X))
Interpretation:
• minimum score: -32
• maximum score: around 300 (depends on age)
• A score >= 120 is associated with a 1.7% probability of resistant bacteremia.
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