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Predicting Probability of Perirectal Colonization with Carbapenem-Resistant Enterobacteriaceae (CRE) and other Carbapenem-Resistant Organisms (CROs) at Hospital Unit Admission
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March 27 2019
Source: Infect Control Hosp Epidemiol. 40(5):541-550
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Details:
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Alternative Title:Infect Control Hosp Epidemiol
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Description:Background.
Targeted screening for carbapenem-resistant organisms (CROs), including carbapenem-resistant Enterobacteriaceae (CRE) and carbapenemase-producing organisms (CPOs), remains limited; recent data suggest that existing policies miss many carriers. Our objective was to measure the prevalence of CRO and CPO perirectal colonization at hospital unit admission and use machine learning methods to predict probability of CRO and/or CPO carriage.
Methods.
We performed an observational cohort study of all patients admitted to the medical intensive care unit (MICU) or solid organ transplant (SOT) unit at The Johns Hopkins Hospital between July 1, 2016 and July 1, 2017. Admission perirectal swabs were screened for CROs and CPOs. More than 125 variables capturing pre-admission clinical and demographic characteristics were collected from the electronic medical record (EMR) system. We developed models to predict colonization probabilities using decision tree learning.
Results.
Evaluating 2,878 admission swabs from 2,165 patients, we found that 7.5% and 1.3% of swabs were CRO- and CPO-positive, respectively. There was high organism and carbapenemase diversity among CPO isolates. Despite including many characteristics commonly associated with CRO/CPO carriage or infection, overall, decision tree models poorly predicted CRO and CPO colonization (C-statistics 0.57 and 0.58, respectively). In sub-group analysis, however, models did accurately identify patients with recent CRO-positive cultures who use proton-pump inhibitors as having a high likelihood of CRO colonization.
Conclusions.
In this inpatient population, CRO carriage was infrequent but higher than previously published estimates. Despite including many variables associated with CRO/CPO carriage, models poorly predicted colonization status, likely due to significant host and organism heterogeneity.
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Subject:
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Pubmed ID:30915928
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Pubmed Central ID:PMC6613376
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