Predicting antibiotic resistance to community-acquired pneumonia antibiotics in culture-positive patients with healthcare-associated pneumonia.
Predicting antibiotic resistance to community-acquired pneumonia antibiotics in culture-positive patients with healthcare-associated pneumonia.
复制标题
预测医疗相关性肺炎培养阳性患者对社区获得性肺炎抗生素的抗生素耐药性。
DOI：
10.1002/jhm.942
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发表时间：
2012
影响因子：
2.6
通讯作者：
Sloan,KevinL
中科院分区：
文献类型：
--
作者：
Madaras-Kelly,KarlJ;Remington,RichardE;Fan,VincentS;Sloan,KevinL
开发并验证一个模型，以预测对社区获得性肺炎抗生素的耐药性（CAP耐药），在医疗相关性肺炎（HCAP）患者中，并将该模型的预测性能与仅包括指南定义的HCAP标准的模型进行比较。研究背景：美国西北部的六个退伍军人事务医疗中心。患者培养阳性的HCAP住院患者。测量患者根据HCAP指南定义的标准。入院后48小时内获得的相关培养物进行了评估，以确定细菌学和抗生素敏感性。评估入院前一年的医疗记录，以使用logistic回归开发CAP耐药的预测模型。比较了队列开发模型和指南定义模型的预测性能。在375例培养阳性患者中，有118例鉴定出耐药TSCAP微生物。在指南定义的标准中，CAP耐药与以下因素相关（比值比（OR）[95%置信区间（CI）]）：从疗养院入院（2.6 [1.6 - 4.4]）;近期抗生素暴露（1.7 [1.0 - 2.8]）;和既往住院（1.6 [1.0 - 2.6]）。在队列开发模型中，CAP耐药与以下因素相关：从疗养院入院或最近出院（2.3 [1.4 - 3.8]）;入院后90天内耐甲氧西林金黄色葡萄球菌（MRSA）病史阳性（6.4 [2.6 - 17.8]）或91 - 365天（2.3 [0.9 - 5.9]）;头孢菌素暴露（1.8 [1.1 - 2.9]）;近期输注治疗（1.9 [1.0 - 3.5]）;糖尿病（1.7 [1.0 - 2.8]）;重症监护室（ICU）入院（1.6 [1.0 - 2.6]）。队列开发模型的受试者工作特征曲线下面积（aROC [95%CI]）（0.71 [0.65 - 0.77]）显著高于指南定义的模型（0.63 [0.57 - 0.69]）（P= 0.01）。主要基于既往MRSA病史、疗养院居住和特定抗生素暴露的队列开发模型提供了对HCAP中CAP耐药微生物的更好预测。医院医学杂志2011; © 2011医院医学学会。
OBJECTIVETo develop and validate a model to predict resistance to community‐acquired pneumonia antibiotics (CAP‐resistance) among patients with healthcare‐associated pneumonia (HCAP), and to compare the model's predictive performance to a model including only guideline‐defined criteria for HCAP.DESIGNRetrospective cohort study.SETTINGSix Veterans Affairs Medical Centers in the northwestern United States.PATIENTSCulture‐positive inpatients with HCAP.MEASUREMENTSPatients were identified based upon guideline‐defined criteria for HCAP. Relevant cultures obtained within 48 hours of admission were assessed to determine bacteriology and antibiotic susceptibility. Medical records for the year preceding admission were assessed to develop predictive models of CAP‐resistance with logistic regression. The predictive performance of cohort‐developed and guideline‐defined models was compared.RESULTSCAP‐resistant organisms were identified in 118 of 375 culture‐positive patients. Of guideline‐defined criteria, CAP‐resistance was associated (odds ratio (OR) [95% confidence interval (CI)]) with: admission from nursing home (2.6 [1.6‐4.4]); recent antibiotic exposure (1.7 [1.0‐2.8]); and prior hospitalization (1.6 [1.0‐2.6]). In the cohort‐developed model, CAP‐resistance was associated with: admission from nursing home or recent nursing home discharge (2.3 [1.4‐3.8]); positive methicillin‐resistantStaphylococcus aureus(MRSA) history within 90 days of admission (6.4 [2.6‐17.8]) or 91‐365 days (2.3 [0.9‐5.9]); cephalosporin exposure (1.8 [1.1‐2.9]); recent infusion therapy (1.9 [1.0‐3.5]); diabetes (1.7 [1.0‐2.8]); and intensive care unit (ICU) admission (1.6 [1.0‐2.6]). Area under the receiver operating characteristic curve (aROC [95% CI]) for the cohort‐developed model (0.71 [0.65‐0.77]) was significantly higher than for the guideline‐defined model (0.63 [0.57‐0.69]) (P= 0.01).CONCLUSIONSSelect guideline‐defined criteria predicted CAP‐resistance. A cohort‐developed model based primarily on prior MRSA history, nursing home residence, and specific antibiotic exposures provided improved prediction of CAP‐resistant organisms in HCAP.Journal of Hospital Medicine2011; © 2011 Society of Hospital Medicine.