Value of American Thoracic Society guidelines in predicting infection or colonization with multidrug-resistant organisms in critically ill patients

PLoS One. 2014 Mar 19;9(3):e89687. doi: 10.1371/journal.pone.0089687. eCollection 2014.

Abstract

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.

Publication types

  • Clinical Trial
  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acinetobacter baumannii / drug effects
  • Acinetobacter baumannii / growth & development*
  • Acinetobacter baumannii / pathogenicity
  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use
  • China
  • Critical Illness
  • Drug Resistance, Multiple, Bacterial
  • Enterococcus / drug effects
  • Enterococcus / growth & development*
  • Enterococcus / pathogenicity
  • Female
  • Gram-Negative Bacterial Infections / diagnosis*
  • Gram-Negative Bacterial Infections / drug therapy
  • Gram-Negative Bacterial Infections / microbiology
  • Gram-Positive Bacterial Infections / diagnosis*
  • Gram-Positive Bacterial Infections / drug therapy
  • Gram-Positive Bacterial Infections / microbiology
  • Humans
  • Intensive Care Units
  • Male
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / growth & development*
  • Methicillin-Resistant Staphylococcus aureus / pathogenicity
  • Microbial Sensitivity Tests
  • Middle Aged
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • Pseudomonas aeruginosa / drug effects
  • Pseudomonas aeruginosa / growth & development*
  • Pseudomonas aeruginosa / pathogenicity

Substances

  • Anti-Bacterial Agents

Associated data

  • ClinicalTrials.gov/NCT01667991

Grants and funding

This research was supported by the Major Special Projects of Ministry of Health of China (grant number: 201202011), and the Fund of the Key Discipline of Jiangsu Province (grant number KJXW11.3.). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.