Mussa et al reported a score for predicting a biliary tract infection with bacteremia due to Enterococcus faecalis or Enterococcus faecium. The authors are from multiple institutions in Italy and Spain.
Patient selection: biliary tract infection with bacteremia
Parameters:
(1) cholangiocarcinoma
(2) nosocomial (acquired in hospital)
(3) history of carbapenem therapy in previous month
(4) biliary prosthesis
(5) chronic kidney disease stage 4 or 5
Parameter
Finding
Points
cholangiocarcinoma
no
0
yes
7
nosocomial
no
0
yes
6
carbapenem therapy
no
0
yes
5
biliary prosthesis
no
0
yes
4
CKD stage 4 or 5
no
0
yes
2
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 24
• A score >= 3 had a sensitivity of 0.73 and specificity of 0.68 for infection with Enterococcus faecalis or faecium, which gave the maximum Youden index.
• A score <= 6 had a negative predictive value of 0.95-0.96. This group had a rate of infection with Enterococcus faecalis or faecium of 16 to 20%, with the majority of cases.
Performance:
• The area under the ROC curve is 0.74
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