Herrera et al reported a score for identifying a patient with cancer or hematopoietic stem cell transplant who is at risk for carbapenem-resistant Enterobacterales bacteremia. This can help guide the selection of antibiotic therapy. The authors are from multiple institutions in Argentina.
Enterobacterales is the order of bacteria that includes Enterobacteriaceae, Morganellaceae, Yersiniaceae, and other Gram-negative bacteria.
Klebsiella species represent 91.5% of resistant isolates.
Patient selection: bacteremia in a patient with cancer and/or hematopoietic stem cell transplantation (HSCT)
Parameters:
(1) number of days of antibiotic use prior to bacteremia
(2) number of days hospitalized prior to bacteremia
(3) recent colonization with Klebsiella pneumoniae-carbapenemase (KPC)-producing Enterobacterales (transmitted by plasmids)
|
Parameter
|
Finding
|
Points
|
|
number of days of antibiotic use
|
<= 7 days
|
0
|
|
|
> 7 days
|
2
|
|
number of days hospitalized
|
< 10 days
|
0
|
|
|
>= 10 days
|
2
|
|
recent colonization with KPC-producing Enterobacterales
|
no
|
0
|
|
|
yes
|
5
|
where:
• It is unclear if the number of days of antibiotic use refers to the past 30 days or the immediate days before onset.
• Recent colonization refers to detection within one week of the onset of bacteremia.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 9
• A score >= 4 had the highest Youden index with a sensitivity of 0.76 and specificity of 0.84.
• A score >= 7 had a sensitivity of 0.36 and specificity of 0.98. The negative predictive value is 0.91.
Performance:
• The area under the ROC curve is 0.85.
