PMID- 31720894 OWN - NLM STAT- MEDLINE DCOM- 20201005 LR - 20210907 IS - 1435-4373 (Electronic) IS - 0934-9723 (Linking) VI - 39 IP - 2 DP - 2020 Feb TI - A multidrug-resistant microorganism infection risk prediction model: development and validation in an emergency medicine population. PG - 309-323 LID - 10.1007/s10096-019-03727-4 [doi] AB - The aim was to develop a predictive model of infection by multidrug-resistant microorganisms (MDRO). A national, retrospective cohort study was carried out including all patients attended for an infectious disease in 54 Spanish Emergency Departments (ED), in whom a microbiological isolation was available from a culture obtained during their attention in the ED. A MDRO infection prediction model was created in a derivation cohort using backward logistic regression. Those variables significant at p < 0.05 assigned an integer score proportional to the regression coefficient. The model was then internally validated by k-fold cross-validation and in the validation cohort. A total of 5460 patients were included; 1345 (24.6%) were considered to have a MDRO infection. Twelve independent risk factors were identified in the derivation cohort and were combined into an overall score, the ATM (assessment of threat for MDRO) score. The model achieved an area under the curve-receiver operating curve of 0.76 (CI 95% 0.74-0.78) in the derivation cohort and 0.72 (CI 95% 0.70-0.75) in the validation cohort (p = 0.0584). Patients were then split into 6 risk categories and had the following rates of risk: 7% (0-2 points), 16% (3-5 points), 24% (6-9 points), 33% (10-14 points), 47% (15-21 points), and 71% (> 21 points). Findings were similar in the validation cohort. Several patient-specific factors were independently associated with MDRO infection risk. When integrated into a clinical prediction rule, higher risk scores and risk classes were related to an increased risk for MDRO infection. This clinical prediction rule could be used by providers to identify patients at high risk and help to guide antibiotic strategy decisions, while accounting for clinical judgment. FAU - Gonzalez Del Castillo, Juan AU - Gonzalez Del Castillo J AUID- ORCID: 0000-0002-4329-9802 AD - Emergency Department, Hospital Universitario Clinico San Carlos, Calle Profesor Martin Lagos, s/n., 28040, Madrid, Spain. jgonzalezcast@gmail.com. AD - Health Research Institute (IdISSC), Hospital Universitario San Carlos, Madrid, Spain. jgonzalezcast@gmail.com. FAU - Julian-Jimenez, Agustin AU - Julian-Jimenez A AD - Emergency Department, Complejo Hospitalario Universitario de Toledo, Universidad de Castilla La Mancha, Toledo, Spain. FAU - Gamazo-Del Rio, Julio Javier AU - Gamazo-Del Rio JJ AD - Emergency Department, Hospital Universitario de Galdakao-Usansolo, Bizkaia, Spain. FAU - Garcia-Lamberechts, Eric Jorge AU - Garcia-Lamberechts EJ AD - Emergency Department, Hospital Universitario Clinico San Carlos, Calle Profesor Martin Lagos, s/n., 28040, Madrid, Spain. AD - Health Research Institute (IdISSC), Hospital Universitario San Carlos, Madrid, Spain. FAU - Llopis-Roca, Ferran AU - Llopis-Roca F AD - Emergency Department, Hospital Universitario de Bellvitge, Barcelona, Spain. FAU - Guardiola Tey, Josep Maria AU - Guardiola Tey JM AD - Emergency Department, Hospital Universitario Sant Pau. Universidad Autonoma de Barcelona. Universidad Internacional de Catalunya, Barcelona, Spain. FAU - Martinez-Ortiz de Zarate, Mikel AU - Martinez-Ortiz de Zarate M AD - Emergency Department, Hospital Universitario de Basurto, Bilbao, Spain. FAU - Navarro Bustos, Carmen AU - Navarro Bustos C AD - Emergency Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain. FAU - Pinera Salmeron, Pascual AU - Pinera Salmeron P AD - Emergency Department, Hospital Universitario Reina Sofia, Murcia, Spain. FAU - Alvarez-Manzanares, Jesus AU - Alvarez-Manzanares J AD - Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain. FAU - Ortega Romero, Maria Del Mar AU - Ortega Romero MDM AD - Emergency Department, Hospital Clinic, Barcelona, Spain. FAU - Ruiz Grinspan, Martin AU - Ruiz Grinspan M AD - Emergency Department, Hospital Universitario del Henares, Madrid, Spain. FAU - Garcia Gutierrez, Susana AU - Garcia Gutierrez S AD - Research Unit. REDISSEC, Hospital de Galdakao-Usansolo, Bizkaia, Spain. FAU - Martin-Sanchez, Francisco Javier AU - Martin-Sanchez FJ AD - Emergency Department, Hospital Universitario Clinico San Carlos, Calle Profesor Martin Lagos, s/n., 28040, Madrid, Spain. AD - Health Research Institute (IdISSC), Hospital Universitario San Carlos, Madrid, Spain. FAU - Candel Gonzalez, Francisco Javier AU - Candel Gonzalez FJ AD - Health Research Institute (IdISSC), Hospital Universitario San Carlos, Madrid, Spain. AD - Clinical Microbiology Department, Hospital Universitario Clinico San Carlos, Madrid, Spain. CN - INFURG-SEMES investigators (see addedum) LA - eng PT - Journal Article PT - Multicenter Study DEP - 20191113 PL - Germany TA - Eur J Clin Microbiol Infect Dis JT - European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology JID - 8804297 SB - IM MH - Aged MH - Aged, 80 and over MH - Communicable Diseases/diagnosis/*epidemiology/*microbiology MH - *Drug Resistance, Microbial MH - *Drug Resistance, Multiple MH - Emergency Medicine/statistics & numerical data MH - Female MH - Hospitalization MH - Humans MH - Male MH - Middle Aged MH - *Models, Theoretical MH - ROC Curve MH - Reproducibility of Results MH - Retrospective Studies MH - Risk Assessment MH - Risk Factors MH - Severity of Illness Index OTO - NOTNLM OT - Antibiotic resistant OT - Empirical antibiotic treatment OT - MDRO OT - Risk factors OT - Stewardship EDAT- 2019/11/14 06:00 MHDA- 2020/10/06 06:00 CRDT- 2019/11/14 06:00 PHST- 2019/07/29 00:00 [received] PHST- 2019/09/26 00:00 [accepted] PHST- 2019/11/14 06:00 [pubmed] PHST- 2020/10/06 06:00 [medline] PHST- 2019/11/14 06:00 [entrez] AID - 10.1007/s10096-019-03727-4 [pii] AID - 10.1007/s10096-019-03727-4 [doi] PST - ppublish SO - Eur J Clin Microbiol Infect Dis. 2020 Feb;39(2):309-323. doi: 10.1007/s10096-019-03727-4. Epub 2019 Nov 13.