BACKGROUND The prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) has globally increased and spread to the community. No clinical score is available to select carriers in whom these organisms can be empirically targeted at ICU admission. METHODS We prospectively assessed between 2009 and 2017 the prevalence of ESBL-PE infection in carriers at ICU admission. A logistic regression was used to determine independent risk factors associated with ESBL-PE infection, and to build a clinical risk score. RESULTS Of the 8,061 admissions over the study 7-year period, 745 (9%) patients were ESBL-PE carriers at admission, of whom 395 had infections at ICU admission including 59 (15%) who had culture-proven ESBL-PE related infection. By multivariable analysis, age >60 years, cirrhosis, being on broad-spectrum antibiotics within the past three months, urinary or intra-abdominal source of infection, and the absence of chronic pulmonary disease, were the five independent factors associated with ESBL-PE infection in carriers. A clinical risk score ranging from 0 to 7 was built based on these variables, with an area under the receiver operating characteristic curve (ROC) of 0.82 (95% CI 0.78-0.86); p <0.001. The prevalence of ESBL-PE infection for clinical risk scores of 0-1, 2-3, 4-5, or 6-7 was 0%, 4%, 26%, and 49%, respectively. The negative predictive value when Mondor ESBL risk score is <4 was 97%. CONCLUSION ESBL-PE related infection was not common in carriers at ICU admission. A clinical risk score may spare ESBL-PE carriers with lower risk of ESBL-PE infection at ICU admission unnecessary empiric carbapenem therapy.

中文翻译：

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对入院ICU时定植的患者中因产生广谱β-内酰胺酶的肠杆菌科细菌引起的疾病风险进行量化。

背景技术产生广谱β-内酰胺酶的肠杆菌科（ESBL-PE）的流行性在全球范围内增加并传播到社区。没有临床评分可用于选择可以将这些生物凭经验靶向ICU的携带者。方法我们对2009年至2017年在ICU入院的携带者中ESBL-PE感染的患病率进行了前瞻性评估。Logistic回归用于确定与ESBL-PE感染相关的独立危险因素，并建立临床危险评分。结果在为期7年的研究中，共计8,061例入院，其中745（9％）名患者是ESBL-PE携带者，其中ICU入院时有395例感染，其中59例（15％）具有经文化证明的ESBL-PE相关感染。通过多变量分析，年龄> 60岁，肝硬化，在过去三个月内使用广谱抗生素，尿液或腹腔内感染源以及无慢性肺部疾病是与携带者ESBL-PE感染相关的五个独立因素。基于这些变量建立了从0到7的临床风险评分，受试者工作特征曲线（ROC）下的面积为0.82（95％CI 0.78-0.86）；p ＜0.001。临床风险评分为0-1、2-3、4-5或6-7的ESBL-PE感染患病率分别为0％，4％，26％和49％。当Mondor ESBL风险评分<4时，阴性预测值为97％。结论ESBL-PE相关感染在ICU入院的携带者中并不常见。临床风险评分可能会使ESBL-PE携带者在接受ICU入院时不需要ESBL-PE感染的风险较低，而无需进行经验性碳青霉烯类治疗。