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Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients
BACKGROUND: The incidence rate of infection by multidrug-resistant organisms (MDROs) can affect the accuracy of etiological diagnosis when using American Thoracic Society (ATS) guidelines. We determined the accuracy of the ATS guidelines in predicting infection or colonization by MDROs over 18 month...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960103/ https://www.ncbi.nlm.nih.gov/pubmed/24647408 http://dx.doi.org/10.1371/journal.pone.0089687 |
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author | Xie, Jianfeng Ma, Xudong Huang, Yingzi Mo, Min Guo, Fengmei Yang, Yi Qiu, Haibo |
author_facet | Xie, Jianfeng Ma, Xudong Huang, Yingzi Mo, Min Guo, Fengmei Yang, Yi Qiu, Haibo |
author_sort | Xie, Jianfeng |
collection | PubMed |
description | BACKGROUND: The incidence rate of infection by multidrug-resistant organisms (MDROs) can affect the accuracy of etiological diagnosis when using American Thoracic Society (ATS) guidelines. We determined the accuracy of the ATS guidelines in predicting infection or colonization by MDROs over 18 months at a single ICU in eastern China. METHODS: This prospective observational study examined consecutive patients who were admitted to an intensive care unit (ICU) in Nanjing, China. MDROs were defined as bacteria that were resistant to at least three antimicrobial classes, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Pseudomonas aeruginosa, Acinetobacter baumannii. Screening for MDROs was performed at ICU admission and discharge. Risk factors for infection or colonization with MDROs were recorded, and the accuracy of the ATS guidelines in predicting infection or colonization with MDROs was documented. RESULTS: There were 610 patients, 225 (37%) of whom were colonized or infected with MDROs at ICU admission, and this increased to 311 (51%) at discharge. At admission, the sensitivity (70.0%), specificity (31.6%), positive predictive value (38.2%), and negative predictive value (63.5%), all based on ATS guidelines for infection or colonization with MDROs were low. The negative predictive value was greater in patients from departments with MDRO infection rates of 31–40% than in patients from departments with MDRO infection rates of 30% or less and from departments with MDRO infection rates more than 40%. CONCLUSION: ATS criteria were not reliable in predicting infection or colonization with MDROs in our ICU. The negative predictive value was greater in patients from departments with intermediate rates of MDRO infection than in patients from departments with low or high rates of MDRO infection. TRIAL REGISTRATION: ClinicalTrials.gov NCT01667991 |
format | Online Article Text |
id | pubmed-3960103 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-39601032014-03-24 Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients Xie, Jianfeng Ma, Xudong Huang, Yingzi Mo, Min Guo, Fengmei Yang, Yi Qiu, Haibo PLoS One Research Article BACKGROUND: The incidence rate of infection by multidrug-resistant organisms (MDROs) can affect the accuracy of etiological diagnosis when using American Thoracic Society (ATS) guidelines. We determined the accuracy of the ATS guidelines in predicting infection or colonization by MDROs over 18 months at a single ICU in eastern China. METHODS: This prospective observational study examined consecutive patients who were admitted to an intensive care unit (ICU) in Nanjing, China. MDROs were defined as bacteria that were resistant to at least three antimicrobial classes, such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Pseudomonas aeruginosa, Acinetobacter baumannii. Screening for MDROs was performed at ICU admission and discharge. Risk factors for infection or colonization with MDROs were recorded, and the accuracy of the ATS guidelines in predicting infection or colonization with MDROs was documented. RESULTS: There were 610 patients, 225 (37%) of whom were colonized or infected with MDROs at ICU admission, and this increased to 311 (51%) at discharge. At admission, the sensitivity (70.0%), specificity (31.6%), positive predictive value (38.2%), and negative predictive value (63.5%), all based on ATS guidelines for infection or colonization with MDROs were low. The negative predictive value was greater in patients from departments with MDRO infection rates of 31–40% than in patients from departments with MDRO infection rates of 30% or less and from departments with MDRO infection rates more than 40%. CONCLUSION: ATS criteria were not reliable in predicting infection or colonization with MDROs in our ICU. The negative predictive value was greater in patients from departments with intermediate rates of MDRO infection than in patients from departments with low or high rates of MDRO infection. TRIAL REGISTRATION: ClinicalTrials.gov NCT01667991 Public Library of Science 2014-03-19 /pmc/articles/PMC3960103/ /pubmed/24647408 http://dx.doi.org/10.1371/journal.pone.0089687 Text en © 2014 Xie et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Xie, Jianfeng Ma, Xudong Huang, Yingzi Mo, Min Guo, Fengmei Yang, Yi Qiu, Haibo Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients |
title | Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients |
title_full | Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients |
title_fullStr | Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients |
title_full_unstemmed | Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients |
title_short | Value of American Thoracic Society Guidelines in Predicting Infection or Colonization with Multidrug-Resistant Organisms in Critically Ill Patients |
title_sort | value of american thoracic society guidelines in predicting infection or colonization with multidrug-resistant organisms in critically ill patients |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960103/ https://www.ncbi.nlm.nih.gov/pubmed/24647408 http://dx.doi.org/10.1371/journal.pone.0089687 |
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