A "resistance calculator": Simple stewardship intervention for refining empiric practices of antimicrobials in acute-care hospitals.
Infect Control Hosp Epidemiol
; 42(9): 1082-1089, 2021 09.
Article
de En
| MEDLINE
| ID: mdl-33736724
ABSTRACT
OBJECTIVE:
In the era of widespread resistance, there are 2 time points at which most empiric prescription errors occur among hospitalized adults (1) upon admission (UA) when treating patients at risk of multidrug-resistant organisms (MDROs) and (2) during hospitalization, when treating patients at risk of extensively drug-resistant organisms (XDROs). These errors adversely influence patient outcomes and the hospital's ecology. DESIGN ANDSETTING:
Retrospective cohort study, Shamir Medical Center, Israel, 2016. PATIENTS Adult patients (aged >18 years) hospitalized with sepsis.METHODS:
Logistic regressions were used to develop predictive models for (1) MDRO UA and (2) nosocomial XDRO. Their performances on the derivation data sets, and on 7 other validation data sets, were assessed using the area under the receiver operating characteristic curve (ROC AUC).RESULTS:
In total, 4,114 patients were included 2,472 patients with sepsis UA and 1,642 with nosocomial sepsis. The MDRO UA score included 10 parameters, and with a cutoff of ≥22 points, it had an ROC AUC of 0.85. The nosocomial XDRO score included 7 parameters, and with a cutoff of ≥36 points, it had an ROC AUC of 0.87. The range of ROC AUCs for the validation data sets was 0.7-0.88 for the MDRO UA score and was 0.66-0.75 for nosocomial XDRO score. We created a free web calculator (https//assafharofe.azurewebsites.net).CONCLUSIONS:
A simple electronic calculator could aid with empiric prescription during an encounter with a septic patient. Future implementation studies are needed to evaluate its utility in improving patient outcomes and in reducing overall resistances.
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Sepsie
/
Anti-infectieux
Type d'étude:
Observational_studies
/
Prognostic_studies
Limites:
Adult
/
Humans
Langue:
En
Journal:
Infect Control Hosp Epidemiol
Sujet du journal:
DOENCAS TRANSMISSIVEIS
/
ENFERMAGEM
/
EPIDEMIOLOGIA
/
HOSPITAIS
Année:
2021
Type de document:
Article
Pays d'affiliation:
Israël