Gudiol et al reported predictors for a bloodstream infection caused by a multidrug resistant (MDR) Pseudomonas aeruginosa in a neutropenic cancer patient. This can help to identify a patient who may fail initial antibiotic selection. The authors are from multiple institutions from Europe, the Middle East, and South America.
Patient selection: neutropenic (absolute neutrophil count < 0.5 * 10^9/L) cancer patient with positive blood cultures for Pseudomonas aeruginosa
Predictors:
(1) history of therapy with piperacillin/tazobactam (OR 3.48, timeframe not specified))
(2) history of fluoroquinolone prophylaxis (OR 2.99)
(3) history of antipseudomonal carbapenem (OR 2.53, timeframe not specified)
(4) hematologic cancer (OR 2.09)
(5) age in years (OR 0.98)
(6) presence of a urinary catheter (OR 2.54)
|
Parameter
|
Finding
|
Points
|
|
prior piperacillin
|
no
|
0
|
|
|
yes
|
1.2489
|
|
prior fluoroquinolone
|
no
|
0
|
|
|
yes
|
1.0963
|
|
antispeudomonal carbapenem
|
no
|
0
|
|
|
yes
|
0.929
|
|
urinary catheter
|
no
|
0
|
|
|
yes
|
0.9334
|
|
hematologic cancer
|
no
|
0
|
|
|
yes
|
0.7371
|
|
age in years
|
|
-0.0172 * (age)
|
value of X =
= SUM(points for all of the parameters) - 1.6523
probability of MDR pseudomonas =
= 1 / (1 + EXP((-1) * X))
Performance:
• The area under the ROC curve was 0.83 in the derivation and 0.72 in the validation cohorts.
