Vancomycin-Resistant Enterococcus-Positive Blood Cultures: Results From a Province-Wide Multisite Case Series Analysis in Ontario, Canada, January 2009-December 2013
Notice bibliographique
Résumé
Background. Since 2009, all Ontario hospitals are mandated to report vancomycin-resistant Enterococcus (VRE)-positive (+) blood cultures to a provincial public reporting database. The objective of this study was to better understand the clinical characteristics, microbiology and outcomes of patients with VRE+ blood cultures in Ontario, Canada. Methods. A chart review of all cases reported by Ontario hospitals between January 2009 and December 2013 was performed by the Institute for Clinical and Evaluative Sciences using a standardized clinical data abstraction tool. False positives, incomplete or duplicate cases, as well as cases with a missing or invalid health card number were excluded from the analysis. Descriptive statistics were generated using SAS. Results. In total, 311 VRE+ blood cultures were reported. After exclusions, the final study sample was n = 232. Mean age was 61 years (range 1–97 years), 60% were male and 91% had at least one comorbidity, including: renal disease (34%), diabetes (28%), hematological malignancy (23%), non-hematological malignancy (11%) and transplant (solid organ [9%] and bone marrow [3%]); 42% were immunocompromised during their admission prior to their confirmed VRE+ blood culture and over half of patients (55%) were known to be VRE colonized. At the time of blood culture draw, 84% had a central line and 18% were neutropenic. Most VRE+ blood cultures (93%) were due to E. faecium. Although 72% were given empiric antibiotics at the time of blood culture draw, only 17% of patients received effective empiric anti-VRE therapy (linezolid 14%, daptomycin 3%). Overall, 74% of patients with VRE+ blood cultures received effective anti-VRE therapy; not receiving effective anti-VRE therapy was associated with an increased risk of death within 7 days (OR = 4.5; 95% CI, 2.3–9.0). In total, 48% of patients died during their hospitalization. A review of death certificates found that 1% of deaths indicated VRE infection as the primary cause of death. Conclusion. Most VRE+ blood cultures occurred in immunocompromised patients with invasive devices; nearly half of patients died during their hospital admission. Lack of effective anti-VRE therapy was associated with a significantly increased risk of death. Disclosures. All authors: No reported disclosures.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,003 | 0,008 |
| Études des sciences et des technologies | 0,003 | 0,001 |
| Communication savante | 0,002 | 0,000 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».