Predictive Score for Carbapenem-Resistant Gram-Negative Bacilli Sepsis: Single-Center Prospective Cohort Study
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Published:2022-12-23
Issue:1
Volume:12
Page:21
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ISSN:2079-6382
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Container-title:Antibiotics
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language:en
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Short-container-title:Antibiotics
Author:
Gomes Marisa Zenaide RibeiroORCID, Braga Douglas Quintanilha, Pinheiro Debora Otero Britto Passos, Verduc Renata Cristina Amorim Silveira, dos Reis Letícia Vellozo, de Lima Elisangela Martins, Lourenço Newton Dias, Cid Patrícia Aquen, Beck Debora Souza, Pinheiro Luiz Henrique Zanata, Tonhá João Pedro Silva, de Sousa Luiza Silva, Dias Mayra Lopes Secundo, da Silva Machado Amanda Aparecida, Castro Murillo Marçal, Dutra Vitoria Pinson Ruggi, de Mello Luciana Sênos, da Silva Maxuel Cassiano, Tozo Thaisa Medeiros, Mathuiy Yann RodriguesORCID, de Abreu Rosas Lucas Lameirão Pinto, Barros Paulo Cesar Mendes, da Silva Jeane Oliveira, da Silva Priscila Pinho, Bandeira Carolina Souza, de Sant′Anna Reis Di Chiara Salgado Scyla Maria, de Oliveira Alves Marcio Zenaide, Santos Roberto Queiroz, Marques José Aurélio, Rodrigues Caio Augusto Santos, dos Santos Gomes Junior Saint ClairORCID
Abstract
A clinical–epidemiological score to predict CR-GNB sepsis to guide empirical antimicrobial therapy (EAT), using local data, persists as an unmet need. On the basis of a case–case–control design in a prospective cohort study, the predictive factors for CR-GNB sepsis were previously determined as prior infection, use of mechanical ventilation and carbapenem, and length of hospital stay. In this study, each factor was scored according to the logistic regression coefficients, and the ROC curve analysis determined its accuracy in predicting CR-GNB sepsis in the entire cohort. Among the total of 629 admissions followed by 7797 patient-days, 329 single or recurrent episodes of SIRS/sepsis were enrolled, from August 2015 to March 2017. At least one species of CR-GNB was identified as the etiology in 108 (33%) episodes, and 221 were classified as the control group. The cutoff point of ≥3 (maximum of 4) had the best sensitivity/specificity, while ≤1 showed excellent sensitivity to exclude CR-GNB sepsis. The area under the curve was 0.80 (95% CI: 0.76–0.85) and the number needed to treat was 2.0. The score may improve CR-GNB coverage and spare polymyxins with 22% (95% CI: 17–28%) adequacy rate change. The score has a good ability to predict CR-GNB sepsis and to guide EAT in the future.
Funder
Research Support Foundation of the State of Rio de Janeiro National Council for Scientific and Technological Development
Subject
Pharmacology (medical),Infectious Diseases,Microbiology (medical),General Pharmacology, Toxicology and Pharmaceutics,Biochemistry,Microbiology
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