The ICU-CARB score: a novel clinical scoring system to predict carbapenem-resistant gram-negative bacteria carriage in critically ill patients upon ICU admission

被引:2
作者
Dai, Yunqi [1 ]
Zhang, Ling [1 ]
Pan, Tingting [1 ]
Shen, Ziyun [2 ]
Meng, Tianjiao [1 ]
Wu, Jing [1 ]
Gu, Feifei [3 ]
Wang, Xiaoli [1 ]
Tan, Ruoming [1 ]
Qu, Hongping [1 ]
机构
[1] Shanghai Jiao Tong Univ, Sch Med, Ruijin Hosp, Dept Crit Care Med, Shanghai, Peoples R China
[2] Tongji Univ, Shanghai Pulm Hosp, Sch Med, Dept Thorac Surg, Shanghai, Peoples R China
[3] Shanghai Jiao Tong Univ, Sch Med, Ruijin Hosp, Dept Lab Med, Shanghai, Peoples R China
基金
中国国家自然科学基金;
关键词
Carbapenem-resistant gram-negative bacterial; Intensive care unit; Critical patients; Scoring system; Precaution; RISK-FACTORS; COLONIZATION; ENTEROBACTERIACEAE; IDENTIFICATION;
D O I
10.1186/s13756-023-01326-9
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background With the widespread spread of carbapenem-resistant gram-negative bacteria (CR-GNB) in medical facilities, the carriage of CR-GNB among critically ill patients has become a significant concern in intensive care units (ICU). This study aimed to develop a scoring system to identify CR-GNB carriers upon ICU admission.Methods Consecutive critically ill patients admitted to the ICU of Shanghai Ruijin Hospital between January 2017 and December 2020 were included. The patients were then divided into training and testing datasets at a 7:3 ratio. Parameters associated with CR-GNB carriage were identified using least absolute shrinkage and selection operator regression analysis. Each parameter was assigned a numerical score ranging from 0 to 100 using logistic regression analysis. Subsequently, a four-tier risk-level system was developed based on the cumulative scores, and assessed using the area under the receiver operating characteristic curve (AUC).Results Of the 1736 patients included in this study, the prevalence of CR-GNB carriage was 10.60%. The clinical scoring system including seven variables (neurological disease, high-risk department history, length of stay >= 14 days, ICU history, invasive mechanical ventilation, gastrointestinal tube placement, and carbapenem usage) exhibited promising predictive capabilities. Patients were then stratified using the scoring system, resulting in CR-GNB carriage rates of 2.4%, 12.0%, 36.1%, and 57.9% at the respective risk levels (P < 0.001). Furthermore, the AUC of the developed model in the training set was calculated to be 0.82 (95% CI, 0.78-0.86), while internal validation yielded an AUC of 0.83 (95% CI, 0.77-0.89).Conclusions The ICU-CARB Score serves as a straightforward and precise tool that enables prompt evaluation of the risk of CR-GNB carriage at the time of ICU admission, thereby facilitating the timely implementation of targeted pre-emptive isolation.
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页数:10
相关论文
共 41 条
[1]   Screening for carriage of carbapenem-resistant Enterobacteriaceae in settings of high endemicity: a position paper from an Italian working group on CRE infections [J].
Ambretti, Simone ;
Bassetti, Matteo ;
Clerici, Pierangelo ;
Petrosillo, Nicola ;
Tumietto, Fabio ;
Viale, Pierluigi ;
Rossolini, Gian Maria .
ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL, 2019, 8 (01)
[2]  
[Anonymous], 2017, CLSI Document M100-S27, P32
[3]   Early identification and optimal management of carbapenem-resistant Gram-negative infection [J].
Bedos, J. P. ;
Daikos, G. ;
Dodgson, A. R. ;
Pan, A. ;
Petrosillo, N. ;
Seifert, H. ;
Vila, J. ;
Ferrer, R. ;
Wilson, P. .
JOURNAL OF HOSPITAL INFECTION, 2021, 108 :158-167
[4]   Risk Factors and Outcomes Associated with Multidrug-Resistant Acinetobacter baumannii upon Intensive Care Unit Admission [J].
Blanco, Natalia ;
Harris, Anthony D. ;
Rock, Clare ;
Johnson, J. Kristie ;
Pineles, Lisa ;
Bonomo, Robert A. ;
Srinivasan, Arjun ;
Pettigrew, Melinda M. ;
Thom, Kerri A. .
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2018, 62 (01)
[5]   Association between Timing of Colonization and Risk of Developing Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Infection in Hospitalized Patients [J].
Cano, Angela ;
Gutierrez-Gutierrez, Belen ;
Machuca, Isabel ;
Torre-Gimenez, Julian ;
Gracia-Ahufinger, Irene ;
Natera, Alejandra M. ;
Perez-Nadales, Elena ;
Jose Caston, Juan ;
Rodriguez-Bano, Jesus ;
Martinez-Martinez, Luis ;
Torre-Cisneros, Julian .
MICROBIOLOGY SPECTRUM, 2022, 10 (02)
[6]  
CDC, 2015, CRE Toolkit-guidance for control of carbapenem-resistant Enterobacteriaceae (CRE)
[7]   Validation and Extrapolation of a Multimodal Infection Prevention and Control Intervention on Carbapenem-Resistant Klebsiella pneumoniae in an Epidemic Region: A Historical Control Quasi-Experimental Study [J].
Dai, Yunqi ;
Meng, Tianjiao ;
Wang, Xiaoli ;
Tang, Bin ;
Wang, Feng ;
Du, Ying ;
Qiu, Yuzhen ;
Liu, Jialin ;
Tan, Ruoming ;
Qu, Hongping .
FRONTIERS IN MEDICINE, 2021, 8
[8]   Predicting acquisition of carbapenem-resistant Gram-negative pathogens in intensive care units [J].
Dantas, L. F. ;
Dalmas, B. ;
Andrade, R. M. ;
Hamacher, S. ;
Bozza, F. A. .
JOURNAL OF HOSPITAL INFECTION, 2019, 103 (02) :121-127
[9]   Epidemiology of carbapenem resistant Klebsiella pneumoniae colonization in an intensive care unit [J].
Debby, B. D. ;
Ganor, O. ;
Yasmin, M. ;
David, L. ;
Nathan, K. ;
Ilana, T. ;
Dalit, S. ;
Smollan, G. ;
Galia, R. .
EUROPEAN JOURNAL OF CLINICAL MICROBIOLOGY & INFECTIOUS DISEASES, 2012, 31 (08) :1811-1817