• Chung-Hsun Lee, Feng-Yuan Chu, Chih-Chia Hsieh, Ming-Yuan Hong, Chih-Hsien Chi, Wen-Chien Ko, and Ching-Chi Lee.
• aDepartment of Emergency Medicine, National Cheng Kung University Hospital bDepartment of Medicine, National Cheng Kung University Medical College cDepartment of Emergency Medicine, Chi-Mei Medical Center dDepartment of Internal Medicine, National Cheng Kung University Hospital eDivision of Critical Care Medicine, Department of Internal Medicine, Madou Sin-Lau Hospital fGraduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan.
• Medicine (Baltimore). 2017 Apr 1; 96 (16): e6648.

AbstractThe incidence of community-onset bacteremia caused by extended-spectrum-β-lactamase (ESBL) producers is increasing. The adverse effects of ESBL production on patient outcome have been recognized and this antimicrobial resistance has significant implications in the delay of appropriate therapy. However, a simple scoring algorithm that can easily, inexpensively, and accurately be applied to clinical settings was lacking. Thus, we established a predictive scoring algorithm for identifying patients at the risk of ESBL-producer infections among patients with community-onset monomicrobial Enterobacteriaceae bacteremia (CoMEB).In a retrospective cohort, multicenter study, adults with CoMEB in the emergency department (ED) were recruited during January 2008 to December 2013. ESBL producers were determined based on ESBL phenotype. Clinical information was obtained from chart records.Of the total 1141 adults with CoMEB, 65 (5.7%) caused by ESBL producers were identified. Four independent multivariate predictors of ESBL-producer bacteremia with high odds ratios (ORs)-recent antimicrobial use (OR, 15.29), recent invasive procedures (OR, 12.33), nursing home residents (OR, 27.77), and frequent ED user (OR, 9.98)-were each assigned +1 point to obtain the CoMEB-ESBL score. Using the proposed scoring algorithm, a cut-off value of +2 yielded a high sensitivity (84.6%) and an acceptable specificity (92.5%); the area under the receiver operating characteristic curve was 0.92.In conclusion, this simple scoring algorithm can be used to identify CoMEB patients with a high ESBL-producer infection risk. Of note, frequent ED user was firstly demonstrated to be a crucial predictor in predicting ESBL-producer infections. ED clinicians should consider adequate empirical therapy with coverage of these pathogens for patients with risk factors.

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