Wang et al reported a clinical tool for predicting an extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-EB) bloodstream infection in a solid organ transplant recipient. This can help in the selection of initial antibiotic therapy. The authors are from the University of Pennsylvania, Johns Hopkins University, University of Maryland and the University of North Carolina.
Patient selection: solid organ transplant recipient with bloodstream infection (BSI)
Parameters:
(1) ESBL-EB organism isolated on a prior culture
(2) E. coli isolated from a prior culture
(3) Enterobacterales organism isolated from prior urinary culture
(4) exposure to third generation cephalosporin in past 6 months
(5) exposure to trimethoprim-sulfamethoxazole in past 6 months
(6) exposure to an aminoglycoside in past 6 months
(7) mechanical ventilation in past 48 hours
(8) hypotension in past 48 hours
(9) receipt of non-corticosteroid immunomodulator in prior 30 days
(10) corticosteroid-containing chronic immunosuppressive regimen at time of BSI
|
Parameter
|
Finding
|
Points
|
|
ESBL-EB isolate
|
no
|
0
|
|
|
yes
|
5
|
|
E.coli isolated
|
no
|
0
|
|
|
yes
|
-1
|
|
Enterobacterales isolated urine culture
|
no
|
0
|
|
|
yes
|
-2
|
|
third generation cephalosporin exposure
|
no
|
0
|
|
|
yes
|
3
|
|
trimethoprim-sulfamethoxazole exposure
|
no
|
0
|
|
|
yes
|
2
|
|
aminoglycoside exposure
|
no
|
0
|
|
|
yes
|
1
|
|
mechanical ventilation
|
no
|
0
|
|
|
yes
|
2
|
|
hypotension
|
no
|
0
|
|
|
yes
|
1
|
|
non-corticosteroid immunosuppression
|
no
|
0
|
|
|
yes
|
2
|
|
corticosteroid-containing immunosuppression
|
no
|
0
|
|
|
yes
|
2
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: -3
• maximum score: 18
• The higher the score the greater the risk.
• A score >= 2 had a sensitivity of 0.7 and specificity of 0.8. The PPV was 0.5 and NPV 0.9.
Performance:
• The area under the ROC curve is 0.81.
