Development and validation of a bedside risk score for MRSA among patients hospitalized with complicated skin and skin structure infections.
Development and validation of a bedside risk score for MRSA among patients hospitalized with complicated skin and skin structure infections.
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DOI：
10.1186/1471-2334-12-154
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发表时间：
2012-07-11
影响因子：
3.7
通讯作者：
Shorr AF
中科院分区：
文献类型：
--
作者：
Zilberberg MD;Chaudhari P;Nathanson BH;Campbell RS;Emons MF;Fiske S;Hays HD;Shorr AF
耐甲氧西林金黄色葡萄球菌（MRSA）是复杂性皮肤和皮肤结构感染（cSSSI）的常见原因。MRSA感染患者需要与非MRSA感染患者不同的经验性治疗，但目前还没有准确的工具来帮助对MRSA cSSSI的风险进行分层。我们试图开发一种简单的床边决策规则，以更准确地定制经验覆盖范围。我们在2005年4月至2009年3月期间在美国数据库中进行了一项大型多中心（N=62家医院）回顾性队列研究。纳入了具有cSSSI特定ICD-9-CM代码的所有成人首次入院。比较了MRSA与非MRSA患者的基线人口统计学、临床和医院特征。我们开发并验证了一种预测MRSA风险的模型，并通过敏感性、特异性和其他分类统计数据将其性能与医疗保健相关（HCA）感染风险因素进行了比较。在7,183例cSSSI患者中，2,387例（33.2%）患有MRSA。区分MRSA与非MRSA的因素是年龄、非裔美国人种族、无糖尿病、癌症或肾功能不全的证据以及既往心律失常史。评分范围为0 - 8分，表现出一致的剂量-反应关系。MRSA评分5分或更高在所有特征上上级HCA分类，而4分或更高在除特异性外的所有指标上上级HCA分类。MRSA存在于所有住院cSSSI的1/3中。一个简单的床边风险评分可以帮助区分MRSA与其他病原体的风险，与HCA定义相比，准确性更高。
Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of complicated skin and skin structure infections (cSSSI). Patients with MRSA require different empiric treatment than those with non-MRSA infections, yet no accurate tools exist to aid in stratifying the risk for a MRSA cSSSI. We sought to develop a simple bedside decision rule to tailor empiric coverage more accurately. We conducted a large multicenter (N=62 hospitals) retrospective cohort study in a US-based database between April 2005 and March 2009. All adult initial admissions with ICD-9-CM codes specific to cSSSI were included. Patients admitted with MRSA vs. non-MRSA were compared with regard to baseline demographic, clinical and hospital characteristics. We developed and validated a model to predict the risk of MRSA, and compared its performance via sensitivity, specificity and other classification statistics to the healthcare-associated (HCA) infection risk factors. Of the 7,183 patients with cSSSI, 2,387 (33.2%) had MRSA. Factors discriminating MRSA from non-MRSA were age, African-American race, no evidence of diabetes mellitus, cancer or renal dysfunction, and prior history of cardiac dysrhythmia. The score ranging from 0 to 8 points exhibited a consistent dose–response relationship. A MRSA score of 5 or higher was superior to the HCA classification in all characteristics, while that of 4 or higher was superior on all metrics except specificity. MRSA is present in 1/3 of all hospitalized cSSSI. A simple bedside risk score can help discriminate the risk for MRSA vs. other pathogens with improved accuracy compared to the HCA definition.