Identification and validation of a risk assessment scoring tool for extended-spectrum beta-lactamase-producing Enterobacterales bacteremia at a tertiary teaching hospital

Objective: To identify institution-specific risk factors for extended-spectrum beta-lactamase (ESBL) bloodstream infections (BSI) to develop and validate a risk assessment scoring tool that can be utilized for hospitalized patients. Design: Single-center, retrospective, case-control study. Setting: Tertiary teaching hospital. Patients: Hospitalized adult and pediatric patients with E. coli or Klebsiella spp. BSI were stratified based on ESBL production between August 2019 to July 2021. Exclusion criteria included patients < 28 days old, a positive blood culture resulting prior to admission/after discharge or a polymicrobial and/or carbapenem-resistant BSI. Methods: Multivariable logistic regression assessed predictors of ESBL in a derivation cohort. Predictors were applied to a novel validation BSI cohort using area under the receiver-operator characteristics curve (ROC AUC) to assess the reliability of identifying patients likely to harbor ESBL at the time of organism identification. Results: A total of 238 patients in the derivation cohort met inclusion criteria stratified as ESBL (n = 68) or non-ESBL (n = 170). Multivariable logistic regression demonstrated diabetes, 30-day history of invasive procedure or antibiotic use, and/or history of ESBL as independent predictors of ESBL. After creation of an ESBL risk assessment tool, the results were applied to a validation cohort of 170 patients. This model displayed good calibration and discrimination with a strong predictive power (Hosmer-Lemeshow χ²= 4.66, p = 0.19; ROC AUC = 0.88, 95% CI = 0.7909 – 0.974). Conclusions: A validated ESBL risk assessment tool reliably identified hospitalized patients likely to harbor ESBL E. coli or Klebsiella spp. BSI upon organism identification.