How to predict ESBL (part 4)

Two months ago I provided an update on the ESBL-predict study that Tim Deelen from our group coordinates. In short: Every hospital in the world can participate, through a user-friendly electronic CRF (in a secured environment), in the validation of 2 scoring systems to predict that sepsis is caused by ESBL-producing bacteria. Only relevant for those of us that are not yet ready to start meropenem/amikacine for every patient that starts with antibiotics! This tool may help, …. if reliable. We passed the 3,000 episodes! Here is a short update and info for those that want to join.

In short: Wouter Rottier (PhD student) developed 2 prediction rules (for community-onset and hospital-onset infection) for predicting the presence of ESBL-producing bacteria as a cause of infection at the time antibiotics must be started. As these rules did better than current guideline recommendations (especially for reducing unnecessary carbapenem use) when derived, external validation is needed. So, we created  an eCRF for the scores at the day empiric treatment starts (5 minutes work) and to enter culture results 5 days later (another 2 minutes).

We now have data in from 9 countries (not sure why Tim merged Spain and Portugal), and 70 episodes of bacteremia caused by ESBL-producing bacteria (2.2%).  Of all episodes with E.coli and Klebsiella species, 17.1% and 30.1% are resistant to 3rd generation cephalosporins, respectively. Initially, we aimed for 20,000 episodes, but since the observed incidence of ESBL-bacteremia is higher than expected, we may have reliable data with less! Data are coming in on a daily basis and rumor has it that UK sites are preparing! And Tim is in Rumania this week to spread the word.

ESBL1

ESBL2

Bottomline: you all can join the “ESBL-prediction movement”. For more details (e.g., coauthor rules) contact Tim Deelen:  j.w.t.deelen@umcutrecht.nl; telephone +31 88 7569616

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