Ciobotaro et al developed a score for identifying a patient with a history of carbapenem-resistant Enterobacteriacea (CRE) who is likely to be still colonized on a subsequent readmission. This can help to identify a patient who may benefit from more aggressive management. The authors are from Kaplan Medical Center, Hebrew University, Clalit Health Services and Ben-Gurion University in Israel.
Patient selection: positive for Carbapenem-resistant Enterobacteriaceae (CRE) during an index hospital stay
Outcome: persistent Carbapenem-resistant Enterobacteriaceae (CRE) on a subsequent hospital readmission
Parameters:
(1) time from last hospital discharge
(2) CRE status on last hospital admission
(3) Norton score for pressure ulcer (range from 5 to 20)
(4) diabetes mellitus
Parameter
Finding
Points
time from last discharge
< 1 month
4
1 to 3 months
4
4 to 6 months
2
>= 7 months
0
CRE status on last admission
positive
3
negative
0
Norton score
<= 9
2
10 to 14
1
>= 15
0
diabetes mellitus
yes
1
no
0
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
Total Score
Risk Group
Carriage on Readmission
0 to 5
low
8.6%
6 or 7
intermediate
39%
8 to 10
high
77%
Performance:
• The area under the ROC curve is 0.79 (derivation set) and 0.86 (validation set).
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