Score of Martin et al for Distinguishing Carbapenem-Resistant from Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae

Description

Martin et al developed a bedside score for evaluating a patient infected with Enterobacteriaceae species in a region with antibiotic-resistant strains. This can help to distinguish extended spectrum beta-lactamase (ESBL) producing bacteria from carbapenem-resistant ones. The authors are from Wayne State University and Detroit Medical Center.

Patient selection: infection with Enterobacteriaceae in a region endemic for antibiotic-resistant strains

Parameters:

(1) neurologic disease

(2) functional status on admission

(3) diabetes mellitus

(4) admitted to ICU

(5) history of antibiotic exposure within 3 months prior to admission

Parameter	Finding	Points
neurologic disease	no	0
	yes	14
functional status on admission	not dependent	0
	dependent	7
diabetes mellitus	no	0
	yes	12
admitted to ICU	no	0
	yes	11
history of antibiotic exposure	no	0
	yes	7

total score =

= SUM(points for all 5 parameters)

Interpretation:

• minimum score: 0

• maximum score: 51

• A score >= 32 is associated with high risk for carbapenem resistance.

• A patient considered high risk for carbapenem-resistant Enterobacteriaceae may be treated with carbapenem plus polymyxin as opposed to carbapenum alone.

Performance:

• The sensitivity was 81% and specificity 70%.

• The area under the ROC curve was 0.80.

• The negative predictive value was 97% but the positive predictive value was 21%

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Description

Specialty

ICD-10