Leibman et al reported a simple score to aid in the distinction of carbapenem-resistant Enterobacteriaceae from extended spectrum beta-lactamase producing Enterobacteriaceae This distinction allows for better use of antibiotics in a vulnerable population. The authors are from Tel-Aviv University, Assaf Harofeh Medical Center, Wayne State University and the University of Michigan.
Patient selection: bloodstream infection with Enterobacteriaceae
Parameters:
(1) chemotherapy in the prior 3 months
(2) permanent foreign invasive device
(3) peripheral vascular disease
(4) mental status (consciousness, cognition) at the time of acute illness
(5) days in hospital prior to onset of bloodstream infection
(6) age in years
Parameter
Finding
Points
chemotherapy
in past 3 months
19
none or > 3 months
0
foreign device
no
0
yes
10
peripheral vascular disease
no
10
yes
0
mental status
normal
0
reduced
9
days in hospital before onset
<= 3 days
0
> 3 days
7
age in years
< 65 years of age
6
>= 65 years of age
0
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 61
• A score >= 32 indicates high risk of carbapenem resistance.
Performance:
• The sensitivity was 0.59 and specificity 0.76.
• The negative predictive value is 0.90 and positive predictive value 0.34.
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