ReviewClinical prediction models for ESBL-Enterobacteriaceae colonization or infection: a systematic review
Introduction
Several studies have suggested that infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (i.e. Escherichia coli, Klebsiella spp., and Proteus mirabilis) (ESBL-EKP) have an important clinical impact, and the increasing prevalence of these organisms in hospitals has been well documented [1], [2], [3]. β-Lactamase resistance among certain Gram-negative bacteria has been associated with increased mortality, length of hospitalization, and hospital costs. A study by Schwaber et al. concluded that infection with an ESBL-producing organism was associated with an adjusted 3.6-fold increased risk of in-hospital mortality, an unadjusted 2.3-fold increased risk of infection-related mortality, an adjusted 1.6-fold increase in length of stay, an adjusted 25-fold increased risk of delay in appropriate therapy, and an unadjusted 4-fold-increased likelihood of discharge to a long-term care facility for those who survived [4]. In view of these potential complications, it is important to implement measures to combat resistance, develop treatment strategies to overcome the adverse consequences of resistance, and to identify patients at risk of resistance early and accurately, so that effective antibiotic therapy can be given.
Precise determination of risk factors for ESBL-EKP infection may assist in accurate targeting of empirical carbapenem therapy; with appropriate therapy, there should be a decline in treatment failure, infectious complications, antibiotic costs, and the risk of selecting carbapenem resistance [5], [6]. A risk discrimination tool that can identify patients likely to harbour ESBL-EKP might therefore assist with rational antibiotic prescribing and the early implementation of infection control precautions [7].
Several clinical scoring tools have been published since 2011 [7], [8], [9], [10]. Attempts to develop or validate these scoring tools have been made by different study groups in different populations and their findings have been heterogeneous. To our knowledge, no previous systematic review of clinical risk scoring systems for predicting ESBL-EKP colonization or infection in hospitalized patients has been published. Therefore, we aimed to carry out a systematic review, to describe and give an overview of these scoring systems, and to compare and contrast the scores to assist clinicians in their use in clinical practice.
Section snippets
Methods
The Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies (CHARMS) Checklist was followed to guide the framing of the review aim, search strategy, and study inclusion and exclusion criteria [11]. The review was prospectively registered in PROSPERO [12]. Reporting of the review was consistent with PRISMA guidelines [13].
Study selection
Our search identified 1795 articles after removal of duplicates. Only four articles meeting the inclusion criteria were included in the systematic review (Figure 1) [7], [8], [9], [10]. The earliest study was published in 2011 and the most recent was published in 2017.
Study design and participants
Two types of study design were used: retrospective matched case–control studies [8], [9] and cohort studies [7], [10]. Only one study performed an external prospective validation of the prediction model derived from their
Discussion
In the last two decades, extensive use of broad-spectrum β-lactams has led to the emergence of antibiotic-resistant strains of Enterobacteriaceae, including ESBL-EKP [1], [15], [16]. β-Lactams are most commonly used for the treatment of bacterial infections. The persistent exposure of bacterial strains to a multitude of β-lactams has induced dynamic and continuous production, and mutation of the β-lactamase enzymes in these bacteria, expanding their activity to newly developed β-lactam
Conflict of interest statement
None declared.
Funding sources
None.
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2021, Journal of Hospital InfectionCitation Excerpt :This could incorporate information known to be associated with the risk of ESBL-PE infection in carriers such as the source of infection (urinary, intra-abdominal), relative faecal abundance of ESBL-PE, and severity of the infection. Recent studies have attempted to build a predictive score for the risk of ESBL-PE infection in carrier patients [9,10]. These scores most often include age, prior antibiotic therapy, and source of infection (urinary and intra-abdominal).