Gonzalez del Castillo et al developed a score for predicting multi-drug resistance (MDR) in a patient in the Emergency Department. The authors are from multiple institutions in Spain.
Patient selection: Emergency Department patient
Parameters:
(1) age of the patient in years
(2) congestive heart failure (CHF)
(3) diabetes mellitus with end-organ damage
(4) indwelling urinary catheter
(5) recurrent urinary tract infections (UTIs)
(6) institutionalization
(7) number of cycles of antibiotics in the previous year
(8) colonization with antibiotic resistant organism (MRSA, ESBLE, carbapenamase-produce Enterobacteriaceae, MDR Pseudomonas aeruginosa)
(9) antibiotic treatment within the past 90 days (< 3 months)
(10) hospital admission within the past 90 days (< 3 months)
(11) functional status
(12) presence of a skin and soft tissue infection
|
Parameter |
Finding |
Points |
|
age in years |
< 80 years |
0 |
|
|
>= 80 years |
2 |
|
congestive heart failure |
no |
0 |
|
|
yes |
3 |
|
diabetes with end-organ damage |
no |
0 |
|
|
yes |
3 |
|
indwelling urinary catheter |
no |
0 |
|
|
yes |
6 |
|
recurrent UTIs |
no |
0 |
|
|
yes |
3 |
|
institutionalization |
no |
0 |
|
|
yes |
8 |
|
number of previous antibiotic cycles in past year |
<= 3 |
0 |
|
|
> 3 |
4 |
|
colonization |
no |
0 |
|
|
yes |
15 |
|
antibiotic therapy in past 90 days |
no |
0 |
|
|
yes |
4 |
|
hospital admission in the past 90 days |
no |
0 |
|
|
yes |
3 |
|
functional status |
no or mild dependence |
0 |
|
|
moderate dependence |
2 |
|
|
severe dependence |
5 |
|
skin and soft tissue infection |
no |
0 |
|
|
yes |
4 |
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 60
|
Total Score |
Percent MDR Bacteria |
|
0 to 2 |
7% |
|
3 to 5 |
16% |
|
6 to 9 |
24% |
|
10 to 14 |
33% |
|
15 to 21 |
47% |
|
> 21 |
71% |
Performance:
• The area under the ROC curve is 0.76.
Specialty: Infectious Diseases
