A decision tree using patient characteristics to predict resistance to commonly used broad-spectrum antibiotics in children with gram-negative bloodstream infections

Anna C. Sick-Samuels, Katherine E. Goodman, Glenn Rapsinski, Elizabeth Colantouni, Aaron M. Milstone, Andrew J. Nowalk, Pranita D. Tamma

Research output: Contribution to journalArticlepeer-review

Abstract

Background. As rates of multidrug-resistant gram-negative infections rise, it is critical to recognize children at high risk of bloodstream infections with organisms resistant to commonly used empiric broad-spectrum antibiotics. The objective of the current study was to develop a user-friendly clinical decision aid to predict the risk of resistance to commonly prescribed broad-spectrum empiric antibiotics for children with gram-negative bloodstream infections. Methods. This was a longitudinal retrospective cohort study of children with gram-negative bacteria cared for at a tertiary care pediatric hospital from June 2009 to June 2015. The primary outcome was a bloodstream infection due to bacteria resistant to broad-spectrum antibiotics (ie, cefepime, piperacillin-tazobactam, meropenem, or imipenem-cilastatin). Recursive partitioning was used to develop the decision tree. Results. Of 689 episodes of gram-negative bloodstream infections included, 31% were resistant to broad-spectrum antibiotics. The decision tree stratified patients into high- or low-risk groups based on prior carbapenem treatment, a previous culture with a broad-spectrum antibiotic resistant gram-negative organism in the preceding 6 months, intestinal transplantation, age ≥3 years, and ≥7 prior episodes of gram-negative bloodstream infections. The sensitivity for classifying high-risk patients was 46%, and the specificity was 91%. Conclusion. A decision tree offers a novel approach to individualize patients' risk of gram-negative bloodstream infections resistant to broad-spectrum antibiotics, distinguishing children who may warrant even broader antibiotic therapy (eg, combination therapy, newer β-lactam agents) from those for whom standard empiric antibiotic therapy is appropriate. The constructed tree needs to be validated more widely before incorporation into clinical practice.

Original languageEnglish (US)
Pages (from-to)142-149
Number of pages8
JournalJournal of the Pediatric Infectious Diseases Society
Volume9
Issue number2
DOIs
StatePublished - 2020

Keywords

  • Antibiotic stewardship
  • Bloodstream infections
  • Multidrug-resistant gram-negative organisms
  • Recursive partitioning

ASJC Scopus subject areas

  • Medicine(all)

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