No Crystal Ball? Using Risk Factors and Scoring Systems to Predict Extended-Spectrum Beta-Lactamase Producing Enterobacterales (ESBL-E) and Carbapenem-Resistant Enterobacterales (CRE) Infections

Purpose of Review Predicting whether a hospitalized patient is infected with an ESBL-E or CRE remains challenging and often leads to overutilization of broad-spectrum antibiotics. This review will describe the most common risk factors associated with ESBL-E and CRE infections and how to best apply them to clinical practice. A review of existing risk scoring tools to predict multidrug-resistant gram-negative pathogens (MDR GN) as well as considerations for implementation will be discussed. Recent Findings Prior use of a fluoroquinolone or broad-spectrum beta-lactam with the past 3 months, history of colonization or infection with an ESBL-E or CRE within the past year, presence of an indwelling device, and transfer from a long-term care facility are four shared risk factors for ESBL-E and CRE and should be considered when selecting empiric antimicrobial therapy. Adoption of a risk scoring tool can also help clinicians determine appropriate empiric antimicrobial therapy if appropriately validated against local data. Identifying individual risk factors for MDR GN and utilization of risk scoring systems are valuable tools to optimize empiric antibiotic decision-making.