The Novel "RISC" Score as a Risk-prediction Model of Carbapenem-resistant Hospital-acquired Infections in Adult...

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Antimicrobial Stewardship

Background:

• Antimicrobial sensitivity (AMS) reports for gram-negative (GN) hospital-acquired infections (HAI) often have a delayed availability ( > 72 hours).
• Early prediction of carbapenem-resistant infection (CRI) is vital for appropriate empirical antibiotic selection in GN sepsis.

Purpose of the Study:

• To identify independent predictors of CRI in adult patients diagnosed with GN sepsis and HAI.
• To inform timely and judicious antibiotic therapy decisions.

Main Methods:

• A single-center prospective observational study was conducted from April 2023 to September 2024.
• Data collected included empirical carbapenem use, organ dysfunction scores, mNUTRIC scores, inflammation indices, HAI type, AMS reports, and mortality.
• Multivariable logistic regression analysis was employed to identify risk factors.

Main Results:

• Out of 195 GN HAI patients, 145 (74.4%) had CRI.
• Independent risk factors for CRI included: longer ICU stay prior to HAI (aOR 1.155), ventilator-associated pneumonia (VAP) (aOR 4.170), empirical carbapenem use before HAI (aOR 3.164), and septic shock at HAI diagnosis (aOR 4.162).

Conclusions:

• Ventilator-associated pneumonia, prolonged ICU stay, septic shock, and prior empirical carbapenem administration are significant risk factors for CRI in GN sepsis with HAI.
• These findings can aid in developing risk-prediction models for early identification and management of CRI.