The Predictive Utility of Screening VRE Swabs in Selecting Empiric Antibiotics for Sterile-Site Infections
Bibliographic record
Abstract
Background. Vancomycin-resistant Enterococcus (VRE) screening swabs are performed widely as a means of identifying VRE carriers and prevention transmission. We tested whether these results could have unintended benefits in predicting the vancomycin susceptibility of subsequent infections with Enterococcus experienced by these patients. Methods. A retrospective cohort study was conducted using an auto-populated antimicrobial stewardship database. Patients were included if 18 years of age or older, admitted to hospital between 2010 and 2015, and screened for VRE prior to developing an Enterococcus sterile-site infection. Test characteristics were derived using the screening swab result as test variable predicting the presence or absence of VRE in the sterile site Enterococcus species. Results. 619 patients had sterile cultures positive for Enterococcus during the study period. Of these, 488/619 (79%) had previously undergone VRE screening. A total of 19/488 screening swabs were positive for VRE (4%), and a total of 10/488 sterile culture enterococcal isolates were vancomycin resistant (2%). All VRE sterile isolates were E. faecium. The overall specificity of VRE swabs was 97% (92%–99%) and the overall sensitivity was 70% (35%–92%). The positive predictive value was 37% (17%–61%) and the negative predictive value was 99% (98%–100%). The positive likelihood ratio was 28 (14–56) and the negative likelihood ratio was 0.31 (0.12–0.80). A positive VRE screening swab yielded a post-test probability of 0.36 for VRE sterile site infection. In the United States, where the prevalence of VRE among enterococcus sterile isolates is as high as 0.15, a positive VRE screening swab would yield a post-test probability of 0.83 of vancomycin resistance (based on the derived likelihood ratio). Conclusion. Prior VRE screening swab results are a useful tool for predicting vancomycin-resistance among sterile site Enterococcal infections. The results of this study suggest that those with a positive VRE screening swab, in whom Enterococcus is being considered as a potential etiologic agent, should receive empiric treatment with linezolid or daptomycin until culture and sensitivity results are available; this may lead to earlier effective therapy, decreased average length of stay and reduced mortality. Disclosures. All authors: No reported disclosures
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".