J Korean Med Sci.  2019 Apr;34(14):e116. 10.3346/jkms.2019.34.e116.

Clinical Prediction Score for Community-Onset Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella Species

• Kim M
• Song KH
• Kim CJ
• Choe PG
• Park WB
• Bang JH
• Kim ES
• Park SW
• Kim NJ
• Oh MD
• Kim HB

• KMID: 2442650
• DOI: http://doi.org/10.3346/jkms.2019.34.e116

Abstract

BACKGROUND
This study aimed to identify the predictors and build a prediction score for community-onset bloodstream infections (CO-BSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species.
METHODS
All CO-BSIs caused by E. coli and Klebsiella species from 2012 to 2015 were grouped into derivation (BSIs from 2012 to 2014) and validation (BSIs in 2015) cohorts. A prediction score was built using the coefficients of the multivariate logistic regression model from the derivation cohort.
RESULTS
The study included 886 CO-BSIs (594 and 292 in the derivation and validation cohorts, respectively). The independent predictors of CO-BSIs caused by ESBL-producing E. coli and Klebsiella species included: 1) identification of ESBL-producing microorganisms from any clinical culture within one year of admission, 2) beta-lactam or fluoroquinolone treatment within 30 days (with 2 or more courses within 90 days; with 1 course within 90 days), 3) hospitalization within one year, 4) the presence of an indwelling urinary catheter at the time of admission. The area under the curve (AUC) of the clinical prediction score was 0.72 (95% confidence interval [CI], 0.68-0.77). In the validation cohort, the AUC was 0.70 (95% CI, 0.63-0.77).
CONCLUSIONS
The results of this study suggest a simple and easy-to-use scoring system to predict CO-BSIs caused by ESBL-producing E. coli and Klebsiella species.

Keyword

Prediction Score; Community-Onset Infection; Bloodstream Infection; Extended-Spectrum Beta-Lactamase; Escherichia coli; Klebsiella

MeSH Terms

Area Under Curve
beta-Lactamases
Cohort Studies
Escherichia coli*
Escherichia*
Hospitalization
Klebsiella*
Logistic Models
Urinary Catheters
beta-Lactamases