Predictive utility of swab screening for vancomycin-resistant Enterococcus in selection of empiric antibiotics for Enterococcus sterile-site infections: a retrospective cohort study
Bibliographic record
Abstract
<h3>Background:</h3> Swab screening for vancomycin-resistant <i>Enterococcus</i> (VRE) is used to identify VRE carriers and thus prevent transmission of this organism. We tested whether screening results could have unintended benefits in predicting the vancomycin susceptibility of subsequent <i>Enterococcus</i> infections experienced by these patients. <h3>Methods:</h3> We conducted a retrospective cohort study of all patients admitted to a large tertiary care hospital between 2010 and 2015 who underwent swab screening for VRE before experiencing an <i>Enterococcus</i> sterile-site infection. We derived test characteristics using the screening result as the test variable predicting the presence or absence of vancomycin resistance in the sterile-site <i>Enterococcus</i> species. <h3>Results:</h3> Culture results for sterile-site samples were positive for <i>Enterococcus </i>for 619 patients during the study period. Of these, 488 (79%) had previously undergone VRE screening. A total of 19 (4%) of the 488 screening results were positive for VRE, and 10 (2%) of the sterile-site <i>Enterococcus</i> isolates were resistant to vancomycin. The overall specificity of VRE swabs was 97% (95% confidence interval [CI] 96%-99%), sensitivity was 70% (95% CI 35%-93%), the positive likelihood ratio was 28 (95% CI 14-56), and the negative likelihood ratio was 0.31 (95% CI 0.12-0.79). The post-test probability of vancomycin resistance in a sterile-site culture, given a positive result with VRE screening swab, was 37% using study data and 83% using published aggregate prevalence data for VRE in the United States. <h3>Interpretation:</h3> Prior VRE screening swab results represent a useful tool for predicting vancomycin resistance in sterile-site <i>Enterococcus</i> infections. Patients with a positive result for VRE screening swab and <i>Enterococcus</i> identified by culture of sterile-site samples should receive empiric treatment with linezolid or daptomycin until sensitivity results are available.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 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".