Clinical prediction models for ESBL-Enterobacteriaceae colonization or infection: a systematic review

  • S. Mohd Sazlly Lim
    Correspondence
    Corresponding author. Address: Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 434000 Serdang, Selangor, Malaysia. Tel.: +60 127382506.
    Affiliations
    Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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  • P.L. Wong
    Affiliations
    Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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  • H. Sulaiman
    Affiliations
    Infectious Diseases Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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  • N. Atiya
    Affiliations
    Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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  • R. Hisham Shunmugam
    Affiliations
    University of Malaya Library, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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  • S.M. Liew
    Affiliations
    Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Jalan Universiti, Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
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Published:January 14, 2019DOI:https://doi.org/10.1016/j.jhin.2019.01.012

      Summary

      Background

      β-Lactamase resistance among certain Gram-negative bacteria has been associated with increased mortality, length of hospitalization, and hospital costs.

      Aim

      To identify and critically appraise existing clinical prediction models of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-EKP) infection or colonization.

      Methods

      Electronic databases, reference lists, and citations were searched from inception to April 2018. Papers were included in any language describing the development or validation, or both, of models and scores to predict the risk of ESBL-EKP infection or colonization.

      Findings

      In all, 1795 references were screened, of which four articles were included in the review. The included studies were carried out in different geographical locations with differing study designs, and inclusion and exclusion criteria. Most if not all studies lacked external validation and blinding of reviewers during the evaluation of the predictor variables and outcome. All studies excluded missing data and most studies did not report the number of patients excluded due to missing data. Fifteen predictors of infection or colonization with ESBL-EKP were identified. Commonly included predictors were previous antibiotic use, previous hospitalization, transfer from another healthcare facility, and previous procedures (urinary catheterization and invasive procedures).

      Conclusion

      Due to limitations and variations in the study design, clinicians would have to take these differences into consideration when deciding on how to use these models in clinical practice. Due to lack of external validation, the generalizability of these models remains a question. Therefore, further external validation in local settings is needed to confirm the usefulness of these models in supporting decision-making.

      Keywords

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