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PREDICTIVE SCORE FOR CARBAPENEM-RESISTANT GRAM-NEGATIVE BACILLI SEPSIS: SINGLE-CENTER PROSPECTIVE COHORT STUDY
Bactérias gram-negativas
Resistência a antibióticos
Pontuações de risco
Estudo de coorte
Curva ROC
Unidade de Tratamento Intensivo
Gram-negative bacteria
Antibiotic resistance
Risk scores
Cohort study
ROC curve
Intensive care unit
Author
Affilliation
Abstract
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.
Keywords in Portuguese
SepseBactérias gram-negativas
Resistência a antibióticos
Pontuações de risco
Estudo de coorte
Curva ROC
Unidade de Tratamento Intensivo
Keywords
SepsisGram-negative bacteria
Antibiotic resistance
Risk scores
Cohort study
ROC curve
Intensive care unit
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