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No Crystal Ball? Using Risk Factors and Scoring Systems to Predict Extended-Spectrum Beta-Lactamase Producing Enterobacterales (ESBL-E) and Carbapenem-Resistant Enterobacterales (CRE) Infections

  • Healthcare Associated Infections (G Bearman and D Morgan, Section Editors)
  • Published:
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Abstract

Purpose of Review

Predicting whether a hospitalized patient is infected with an ESBL-E or CRE remains challenging and often leads to overutilization of broad-spectrum antibiotics. This review will describe the most common risk factors associated with ESBL-E and CRE infections and how to best apply them to clinical practice. A review of existing risk scoring tools to predict multidrug-resistant gram-negative pathogens (MDR GN) as well as considerations for implementation will be discussed.

Recent Findings

Prior use of a fluoroquinolone or broad-spectrum beta-lactam with the past 3 months, history of colonization or infection with an ESBL-E or CRE within the past year, presence of an indwelling device, and transfer from a long-term care facility are four shared risk factors for ESBL-E and CRE and should be considered when selecting empiric antimicrobial therapy. Adoption of a risk scoring tool can also help clinicians determine appropriate empiric antimicrobial therapy if appropriately validated against local data.

Summary

Identifying individual risk factors for MDR GN and utilization of risk scoring systems are valuable tools to optimize empiric antibiotic decision-making.

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Authors and Affiliations

  1. Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, Baltimore, MD, USA

    Cecilia Li, Kimberly C. Claeys & Emily L. Heil

  2. Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA

    Julie A. Justo

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  1. Cecilia Li
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  2. Kimberly C. Claeys
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Correspondence to Cecilia Li.

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Conflict of Interest

Drs. Li and Heil declare that they have no conflicts of interest. Dr. Claeys reports Advisory Board membership for La Jolla Therapeutics, AbbVie Biotherapeutics, and Melinta Therapeutics, has served on the Speakers Bureau for BioFire Diagnostics, and has received grants from Merck and Co, outside the submitted work. Dr. Justo reports personal fees from bioMerieux, Merck, Spero Therapeutics, Entasis Therapeutics, Therapeutic Research Center, and Shionogi, outside the submitted work.

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Li, C., Claeys, K.C., Justo, J.A. et al. No Crystal Ball? Using Risk Factors and Scoring Systems to Predict Extended-Spectrum Beta-Lactamase Producing Enterobacterales (ESBL-E) and Carbapenem-Resistant Enterobacterales (CRE) Infections. Curr Infect Dis Rep 24, 147–158 (2022). https://doi.org/10.1007/s11908-022-00785-2

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