{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,2,21]],"date-time":"2025-02-21T09:29:30Z","timestamp":1740130170444,"version":"3.37.3"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2019,12,24]],"date-time":"2019-12-24T00:00:00Z","timestamp":1577145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"ASSUCIP"},{"name":"Associa\u00e7\u00e3o de Cuidados Intensivos do Porto"},{"name":"Teaching and Research Department"},{"name":"Departamento de Forma\u00e7\u00e3o, Ensino e Investiga\u00e7\u00e3o"},{"name":"Oporto University Hospital Centre","award":["2014\/169"],"award-info":[{"award-number":["2014\/169"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To develop and validate a clinical model to identify patients admitted to hospital with community-acquired infection (CAI) caused by pathogens resistant to antimicrobials recommended in current CAI treatment guidelines.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>International prospective cohort study of consecutive patients admitted with bacterial infection. Logistic regression was used to associate risk factors with infection by a resistant organism. The final model was validated in an independent cohort.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>There were 527 patients in the derivation and 89 in the validation cohort. Independent risk factors identified were: atherosclerosis with functional impairment (Karnofsky index &amp;lt;70) [adjusted OR (aOR) (95% CI) =\u20092.19 (1.41\u20133.40)]; previous invasive procedures [adjusted OR (95% CI) = 1.98 (1.28\u20133.05)]; previous colonization with an MDR organism (MDRO) [aOR (95% CI) = 2.67 (1.48\u20134.81)]; and previous antimicrobial therapy [aOR (95% CI) =\u20092.81 (1.81\u20134.38)]. The area under the receiver operating characteristics (AU-ROC) curve (95% CI) for the final model was 0.75 (0.70\u20130.79). For a predicted probability \u226522% the sensitivity of the model was 82%, with a negative predictive value of 85%. In the validation cohort the sensitivity of the model was 96%. Using this model, unnecessary broad-spectrum therapy would be recommended in 30% of cases whereas undertreatment would occur in only 6% of cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>For patients hospitalized with CAI and none of the following risk factors: atherosclerosis with functional impairment; previous invasive procedures; antimicrobial therapy; or MDRO colonization, CAI guidelines can safely be applied. Whereas, for those with some of these risk factors, particularly if more than one, alternative antimicrobial regimens should be considered.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jac\/dkz521","type":"journal-article","created":{"date-parts":[[2019,11,28]],"date-time":"2019-11-28T12:10:21Z","timestamp":1574943021000},"page":"1047-1053","source":"Crossref","is-referenced-by-count":0,"title":["Identification of hospitalized patients with community-acquired infection in whom treatment guidelines do not apply: a validated model"],"prefix":"10.1093","volume":"75","author":[{"given":"Teresa","family":"Cardoso","sequence":"first","affiliation":[{"name":"Intensive Care Unit (UCIP) and Hospital Infection Control Committee; Hospital de Santo Ant\u00f3nio, Oporto Hospital Center, University of Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal"}]},{"given":"Pedro Pereira","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Department of Community Medicine, Information and Health Decision Sciences & CINTESIS, Faculty of Medicine, University of Porto, Rua Dr. Pl\u00e1cido Costa, s\/n, 4200-450 Porto, Portugal"}]},{"given":"Cristina","family":"Nunes","sequence":"first","affiliation":[{"name":"Intensive Care Unit and Hospital Infection Control Committee, Hospital de Bragan\u00e7a, Northeastern Local Health Unit, Av. Abade Ba\u00e7al, 5301-852 Bragan\u00e7a, Portugal"}]},{"given":"M\u00f3nica","family":"Almeida","sequence":"first","affiliation":[{"name":"Neurocritical Care Unit and Hospital Infection Control Committee, Hospital de Braga, Sete Fontes - S\u00e3o Victor, 4710-243 Braga, Portugal"}]},{"given":"Joana","family":"Cancela","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal"}]},{"given":"Fernando","family":"Rosa","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3512-0777","authenticated-orcid":false,"given":"Nuno","family":"Rocha-Pereira","sequence":"first","affiliation":[{"name":"Infectious Diseases Department, S\u00e3o Jo\u00e3o Hospital Center, Alameda Prof. Hern\u00e2ni Monteiro, 4200-319 Porto, Portugal"}]},{"given":"In\u00eas","family":"Ferreira","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital de Santo Ant\u00f3nio, Oporto Hospital Center, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal"}]},{"given":"Filipa","family":"Seabra-Pereira","sequence":"first","affiliation":[{"name":"Intensive Care Unit (UCIP) and Hospital Infection Control Committee; Hospital de Santo Ant\u00f3nio, Oporto Hospital Center, University of Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal"}]},{"given":"Prud\u00eancia","family":"Vaz","sequence":"first","affiliation":[{"name":"Internal Medicine Department and Hospital Infection Control Committee, Hospital de Bragan\u00e7a, Northeastern Local Health Unit, Av. Abade Ba\u00e7al, 5301-852 Bragan\u00e7a, Portugal"}]},{"given":"Liliana","family":"Carneiro","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal"}]},{"given":"Carina","family":"Andrade","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal"}]},{"given":"Justin","family":"Davis","sequence":"first","affiliation":[{"name":"Department of Renal Medicine, Barwon Health, Geelong, Victoria 3220, Australia"}]},{"given":"Ana","family":"Mar\u00e7al","sequence":"first","affiliation":[{"name":"Internal Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, R. Dr. Eduardo Torres, Sra. da Hora, Portugal"}]},{"given":"N Deborah","family":"Friedman","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, Barwon Health, Geelong, Victoria 3220, Australia"}]}],"member":"286","published-online":{"date-parts":[[2019,12,24]]},"reference":[{"key":"2020031310475909800_dkz521-B1","doi-asserted-by":"crossref","first-page":"791","DOI":"10.7326\/0003-4819-137-10-200211190-00007","article-title":"Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections","volume":"137","author":"Friedman","year":"2002","journal-title":"Ann Intern Med"},{"key":"2020031310475909800_dkz521-B2","doi-asserted-by":"crossref","first-page":"40.","DOI":"10.1186\/1741-7015-12-40","article-title":"Classification of healthcare-associated infection: a systematic review 10 years after the first proposal","volume":"12","author":"Cardoso","year":"2014","journal-title":"BMC Med"},{"key":"2020031310475909800_dkz521-B3","doi-asserted-by":"crossref","first-page":"E1","DOI":"10.1111\/j.1469-0691.2011.03672.x","article-title":"Guidelines for the management of adult lower respiratory tract infections\u2013full version","volume":"17","author":"Woodhead","year":"2011","journal-title":"Clin Microbiol Infect"},{"key":"2020031310475909800_dkz521-B4","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1093\/cid\/cit734","article-title":"Healthcare-associated pneumonia does not accurately identify potentially resistant pathogens: a systematic review and meta-analysis","volume":"58","author":"Chalmers","year":"2014","journal-title":"Clin Infect Dis"},{"key":"2020031310475909800_dkz521-B5","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1183\/09031936.00141110","article-title":"Guideline-concordant therapy and outcomes in healthcare-associated pneumonia","volume":"38","author":"Attridge","year":"2011","journal-title":"Eur Respir J"},{"key":"2020031310475909800_dkz521-B6","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1164\/rccm.200405-644ST","article-title":"IDSA. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia","volume":"171","year":"2005","journal-title":"Am J Respir Crit Care Med"},{"key":"2020031310475909800_dkz521-B7","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00408-013-9462-8","article-title":"Guideline-concordant antimicrobial therapy for healthcare-associated pneumonia: a systematic review and meta-analysis","volume":"191","author":"Troitino","year":"2013","journal-title":"Lung"},{"key":"2020031310475909800_dkz521-B8","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil","year":"2016","journal-title":"Clin Infect Dis"},{"key":"2020031310475909800_dkz521-B9","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1086\/511159","article-title":"Infectious Diseases Society of America\/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults","volume":"44","author":"Mandell","year":"2007","journal-title":"Clin Infect Dis"},{"key":"2020031310475909800_dkz521-B10","doi-asserted-by":"crossref","first-page":"e103","DOI":"10.1093\/cid\/ciq257","article-title":"International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases","volume":"52","author":"Gupta","year":"2011","journal-title":"Clin Infect Dis"},{"key":"2020031310475909800_dkz521-B11","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1086\/649554","article-title":"Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America","volume":"50","author":"Solomkin","year":"2010","journal-title":"Clin Infect Dis"},{"key":"2020031310475909800_dkz521-B12","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1093\/jac\/dks475","article-title":"Outcome of inadequate empirical antibiotic therapy in emergency department patients with community-onset bloodstream infections","volume":"68","author":"Chen","year":"2013","journal-title":"J Antimicrob Chemother"},{"key":"2020031310475909800_dkz521-B13"},{"key":"2020031310475909800_dkz521-B14","first-page":"196","volume-title":"Evaluation of Chemotherapeutic Agents","author":"Karnofsky","year":"1949"},{"key":"2020031310475909800_dkz521-B15","doi-asserted-by":"crossref","first-page":"e70806.","DOI":"10.1371\/journal.pone.0070806","article-title":"Predisposition, insult\/infection, response and organ dysfunction (PIRO): a pilot clinical staging system for hospital mortality in patients with infection","volume":"8","author":"Cardoso","year":"2013","journal-title":"PloS One"},{"key":"2020031310475909800_dkz521-B16","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1111\/j.1469-0691.2011.03570.x","article-title":"Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance","volume":"18","author":"Magiorakos","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"2020031310475909800_dkz521-B17","doi-asserted-by":"crossref","first-page":"e58418.","DOI":"10.1371\/journal.pone.0058418","article-title":"The impact of healthcare-associated infection on mortality: failure in clinical recognition is related with inadequate antibiotic therapy","volume":"8","author":"Cardoso","year":"2013","journal-title":"PLoS One"},{"key":"2020031310475909800_dkz521-B18","doi-asserted-by":"crossref","first-page":"123","DOI":"10.4103\/2225-6482.172654","article-title":"Drug-resistant pathogens in community-acquired pneumonia","volume":"2","author":"Uranga","year":"2015","journal-title":"Community Acquir Infect"},{"key":"2020031310475909800_dkz521-B19","doi-asserted-by":"crossref","first-page":"1408","DOI":"10.1111\/j.1469-0691.2010.03089.x","article-title":"Epidemiology and clinical features of community-acquired, healthcare-associated and nosocomial bloodstream infections in tertiary-care and community hospitals","volume":"16","author":"Rodriguez-Bano","year":"2010","journal-title":"Clin Microbiol Infect"},{"key":"2020031310475909800_dkz521-B20","doi-asserted-by":"crossref","first-page":"730","DOI":"10.1111\/acem.12672","article-title":"Comparison of clinical prediction models for resistant bacteria in community-onset pneumonia","volume":"22","author":"Self","year":"2015","journal-title":"Acad Emerg Med"},{"key":"2020031310475909800_dkz521-B21","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1097\/MCP.0000000000000263","article-title":"Multidrug-resistant pathogens in patients with pneumonia coming from the community","volume":"22","author":"Sibila","year":"2016","journal-title":"Curr Opin Pulm Med"},{"key":"2020031310475909800_dkz521-B22","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1378\/chest.09-2434","article-title":"Resistant pathogens in nonnosocomial pneumonia and respiratory failure: is it time to refine the definition of health-care-associated pneumonia?","volume":"137","author":"Schreiber","year":"2010","journal-title":"Chest"},{"key":"2020031310475909800_dkz521-B23","doi-asserted-by":"crossref","first-page":"ofy116.","DOI":"10.1093\/ofid\/ofy116","article-title":"Towards a definition for health care-associated infection","volume":"5","author":"Friedman","year":"2018","journal-title":"Open Forum Infect Dis"},{"key":"2020031310475909800_dkz521-B24","doi-asserted-by":"crossref","first-page":"e0119528.","DOI":"10.1371\/journal.pone.0119528","article-title":"Individualizing risk of multidrug-resistant pathogens in community-onset pneumonia","volume":"10","author":"Falcone","year":"2015","journal-title":"PLoS One"},{"key":"2020031310475909800_dkz521-B25","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1136\/thoraxjnl-2013-203384","article-title":"Multidrug-resistant pathogens in hospitalised patients coming from the community with pneumonia: a European perspective","volume":"68","author":"Aliberti","year":"2013","journal-title":"Thorax"}],"container-title":["Journal of Antimicrobial Chemotherapy"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/75\/4\/1047\/32903644\/dkz521.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jac\/article-pdf\/75\/4\/1047\/32903644\/dkz521.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,3,13]],"date-time":"2020-03-13T14:49:34Z","timestamp":1584110974000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jac\/article\/75\/4\/1047\/5686402"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,12,24]]},"references-count":25,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,12,24]]},"published-print":{"date-parts":[[2020,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jac\/dkz521","relation":{},"ISSN":["0305-7453","1460-2091"],"issn-type":[{"type":"print","value":"0305-7453"},{"type":"electronic","value":"1460-2091"}],"subject":[],"published-other":{"date-parts":[[2020,4]]},"published":{"date-parts":[[2019,12,24]]}}}