No Crystal Ball? Using Risk Factors and Scoring Systems to Predict Extended-Spectrum Beta-Lactamase Producing Enterobacterales (ESBL-E) and Carbapenem-Resistant Enterobacterales (CRE) Infections
- Resource Type
- Review Paper
- Authors
- Li, Cecilia; Claeys, Kimberly C.; Justo, Julie A.; Heil, Emily L.
- Source
- Current Infectious Disease Reports. 24(11):147-158
- Subject
- ESBL risk factors
CRE risk factors
Clinical risk scoring tools
Empiric antimicrobial therapy
Antimicrobial resistance
- Language
- English
- ISSN
- 1523-3847
1534-3146
Purpose of Review: Predicting whether a hospitalized patient is infected with an ESBL-E or CRE remains challenging and often leads to overutilization of broad-spectrum antibiotics. This review will describe the most common risk factors associated with ESBL-E and CRE infections and how to best apply them to clinical practice. A review of existing risk scoring tools to predict multidrug-resistant gram-negative pathogens (MDR GN) as well as considerations for implementation will be discussed.Recent Findings: Prior use of a fluoroquinolone or broad-spectrum beta-lactam with the past 3 months, history of colonization or infection with an ESBL-E or CRE within the past year, presence of an indwelling device, and transfer from a long-term care facility are four shared risk factors for ESBL-E and CRE and should be considered when selecting empiric antimicrobial therapy. Adoption of a risk scoring tool can also help clinicians determine appropriate empiric antimicrobial therapy if appropriately validated against local data.Summary: Identifying individual risk factors for MDR GN and utilization of risk scoring systems are valuable tools to optimize empiric antibiotic decision-making.