A Clinical Decision Tree to Predict Whether a Bacteremic Patient Is Infected With an Extended-Spectrum β-Lactamase-Producing Organism
A Clinical Decision Tree to Predict Whether a Bacteremic Patient Is Infected With an Extended-Spectrum β-Lactamase-Producing Organism
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DOI：
10.1093/cid/ciw425
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发表时间：
2016-10-01
影响因子：
11.8
通讯作者：
Tamma, Pranita D.
中科院分区：
文献类型：
--
作者：
Goodman, Katherine E.;Lessler, Justin;Tamma, Pranita D.
我们开发了一个决策树来预测菌血症患者感染产超广谱β-内酰胺酶微生物的可能性。评估1288菌血症患者，我们的决策树的阳性和阴性预测值分别为90.8%和91.9%，respectively.Methods.aEuro积分我们包括患者的千分之一日元18岁以下的菌血症，由于大肠杆菌或克雷伯氏菌属从2008年10月至2015年3月在约翰霍普金斯医院。对头孢曲松最低抑菌浓度为千分之二μ g/mL的菌株进行ESBL确证试验。使用递归划分生成决策树，以确定菌血症患者感染ESBL生产者的可能性。歧视的原始和交叉验证的模型进行了评估，使用接收器工作特征曲线和计算C-statistics.Results。aEuro积分共有1288例菌血症患者符合资格标准。对于194例患者（15%），菌血症是由于确认的ESBL生产者。预测ESBL阳性菌血症的最终分类树包括5个预测因子：ESBL定植/感染史、慢性留置血管硬件、年龄43岁、近期在ESBL高负荷地区住院和6个月内抗生素暴露6天/千日元。决策树的阳性和阴性预测值分别为90.8%和91.9%，respectively.Conclusions.aEuro integral我们的研究结果表明，临床决策树可用于估计菌血症患者感染产ESBL细菌的可能性。递归分区为解决重要的诊断问题提供了一种实用的、用户友好的方法。
We developed a decision tree to predict the likelihood that a patient with bacteremia is infected with an extended-spectrum beta-lactamase-producing organism. Evaluating 1288 bacteremic patients, our decision tree's positive and negative predictive values were 90.8% and 91.9%, respectively.Methods.aEuro integral We included patients a parts per thousand yen18 years of age with bacteremia due to Escherichia coli or Klebsiella species from October 2008 to March 2015 at Johns Hopkins Hospital. Isolates with ceftriaxone minimum inhibitory concentrations a parts per thousand yen2 A mu g/mL underwent ESBL confirmatory testing. Recursive partitioning was used to generate a decision tree to determine the likelihood that a bacteremic patient was infected with an ESBL producer. Discrimination of the original and cross-validated models was evaluated using receiver operating characteristic curves and by calculation of C-statistics.Results.aEuro integral A total of 1288 patients with bacteremia met eligibility criteria. For 194 patients (15%), bacteremia was due to a confirmed ESBL producer. The final classification tree for predicting ESBL-positive bacteremia included 5 predictors: history of ESBL colonization/infection, chronic indwelling vascular hardware, age a parts per thousand yen43 years, recent hospitalization in an ESBL high-burden region, and a parts per thousand yen6 days of antibiotic exposure in the prior 6 months. The decision tree's positive and negative predictive values were 90.8% and 91.9%, respectively.Conclusions.aEuro integral Our findings suggest that a clinical decision tree can be used to estimate a bacteremic patient's likelihood of infection with ESBL-producing bacteria. Recursive partitioning offers a practical, user-friendly approach for addressing important diagnostic questions.