TABLE 1.
Baseline characteristics of cases and controls in the derivation and validation cohortsa
| Derivation Cohortb |
Validation Cohort |
|||||
|---|---|---|---|---|---|---|
| Non-ESBL (N = 404) |
ESBL (N = 135) | P value | Non-ESBL (N = 137) |
ESBL (N = 221) | P value | |
| Demographics | ||||||
| Age (median, IQR), years | 58 (48-65) | 59 (51-65) | .26 | 55 (43-63) | 54 (42-62) | .47 |
| Female | 170 (42.1%) | 57 (42.2%) | .98 | 50 (36.5%) | 93 (42.1%) | .29 |
| Medical comorbidities | ||||||
| Congestive heart failure | 43 (10.6%) | 13 (9.6%) | .74 | 14 (10.2%) | 15 (6.8%) | .28 |
| Diabetes mellitus | 228 (56.4%) | 70 (51.6%) | .35 | 53 (38.7%) | 68 (30.8%) | .12 |
| Chronic kidney disease | 64 (15.8%) | 21 (15.6%) | .94 | 3 (2.2%) | 6 (2.7%) | >.99 |
| End stage renal disease on dialysis | 178 (44.1%) | 56 (41.5%) | .60 | 26 (19.0%) | 35 (15.8%) | .44 |
| End stage liver disease | 92 (22.8%) | 39 (28.9%) | .15 | 8 (5.9%) | 12 (5.4%) | .87 |
| Structural lung disease | 31 (7.7%) | 20 (14.8%) | .01 | 7 (5.1%) | 9 (4.1%) | .64 |
| Severity of illness in prior 48 h | ||||||
| Hypotensionc | 94 (24.1%) | 37 (32.5%) | .07 | 81 (59.1%) | 137 (62.0%) | .59 |
| Mechanical ventilation | 35 (9.0%) | 33 (29.0%) | <.01 | 20 (14.6%) | 44 (19.9%) | .20 |
| Type of organ transplant | ||||||
| Heart transplant | 35 (8.7%) | 12 (8.9%) | .94 | 11 (8.0%) | 11 (5.0%) | .24 |
| Lung transplant | 22 (5.5%) | 17 (12.6%) | .01 | 5 (3.7%) | 14 (6.3%) | .34 |
| Liver transplant | 111 (27.5%) | 50 (37.0%) | .04 | 41 (29.9%) | 76 (34.4%) | .38 |
| Kidney transplant | 248 (61.4%) | 60 (44.4%) | <.01 | 84 (61.3%) | 132 (59.7%) | .77 |
| Pancreas transplant | 14 (3.5%) | 5 (3.7%) | >.99 | 3 (2.2%) | 5 (2.3%) | >.99 |
| Immunosuppressive regimen | ||||||
| Corticosteroidsd | 207 (51.2%) | 92 (68.2%) | <.01 | 119 (86.9%) | 198 (89.6%) | .43 |
| Non-corticosteroid immunomodulatore | 179 (44.3%) | 86 (63.7%) | <.01 | 4 (2.9%) | 30 (13.6%) | <.01 |
| Induction regimen | ||||||
| Any induction | 177 (43.8%) | 58 (43.0%) | .86 | 50 (36.5%) | 75 (33.9%) | .62 |
| Induction with antithymocyte globulin (ATG) | 60 (14.9%) | 10 (7.4%) | .03 | 41 (29.9%) | 63 (28.5%) | .77 |
| Allograft rejection in prior 6 mo | 36 (9.0%) | 18 (13.9%) | .11 | 17 (12.4%) | 19 (8.6%) | .24 |
| Neutropenia at time of BSI f | 20 (5.0%) | 8 (5.9%) | .66 | 16 (11.7%) | 22 (10.0%) | .61 |
| Source of EB BSI | ||||||
| Hepatobiliary | 42 (10.4%) | 11 (8.2%) | .49 | 23 (16.8%) | 38 (17.2%) | .92 |
| Central venous catheter | 38 (9.4%) | 10 (7.4%) | .48 | 25 (18.3%) | 36 (16.3%) | .63 |
| Intra-abdominal (eg, abscess) | 32 (7.9%) | 13 (9.6%) | .53 | 22 (16.1%) | 36 (16.3%) | .95 |
| Pulmonary | 18 (4.5%) | 14 (10.4%) | .01 | 7 (5.1%) | 18 (8.1%) | .27 |
| Skin and soft tissue | 12 (3.0%) | 6 (4.4%) | .41 | 3 (2.2%) | 2 (0.9%) | .38 |
| Genitourinary | 182 (45.1%) | 42 (31.1%) | <.01 | 58 (42.3%) | 94 (42.5%) | .97 |
| Hospitalization in prior 6 mo | 270 (66.8%) | 109 (80.7%) | <.01 | 102 (74.5%) | 160 (72.4%) | .67 |
| Antimicrobial exposures in prior 6 mo | ||||||
| Third-generation cephalosporin | 34 (8.4%) | 33 (24.4%) | <.01 | 25 (18.3%) | 73 (33.0%) | <.01 |
| Cefepime | 57 (14.1%) | 42 (31.1%) | <.01 | 46 (33.6%) | 79 (35.8%) | .68 |
| Piperacillin-tazobactam | 94 (23.3%) | 53 (39.3%) | <.01 | 77 (56.2%) | 130 (58.8%) | .63 |
| Fluoroquinolone | 83 (20.5%) | 44 (32.6%) | <.01 | 50 (36.5%) | 87 (39.4%) | .59 |
| Carbapenem | 24 (5.9%) | 36 (26.7%) | <.01 | 47 (34.3%) | 88 (39.8%) | .30 |
| Aminoglycoside | 15 (3.7%) | 17 (12.6%) | <.01 | 13 (9.5%) | 50 (22.6%) | <.01 |
| Trimethoprim-sulfamethoxazole | 107 (26.5%) | 56 (41.5%) | <.01 | 50 (36.5%) | 105 (47.5%) | .04 |
| Colonization or infection with EB organisms in prior 12 mo | ||||||
| Prior EB on any culture | 159 (43.4%) | 72 (55.0%) | .02 | 66 (48.2%) | 127 (57.5%) | .09 |
| Prior E. coli on any culture | 82 (20.3%) | 30 (22.2%) | .63 | 33 (24.1%) | 43 (19.5%) | .30 |
| Prior Klebsiella on any culture | 63 (15.6%) | 40 (29.6%) | <.01 | 34 (24.8%) | 70 (31.7%) | .17 |
| Prior ESBL-EB on any culture | 11 (2.7%) | 58 (43.0%) | <.01 | 12 (8.8%) | 56 (25.3%) | <.01 |
| Prior EB on blood culture | 12 (3.0%) | 2 (1.5%) | .53 | 24 (17.5%) | 45 (20.4%) | .51 |
| Prior EB on lower respiratory culture | 25 (6.2%) | 25 (18.5%) | <.01 | 16 (11.7%) | 27 (12.2%) | .88 |
| Prior EB on urinary culture | 118 (29.2%) | 42 (31.9%) | .56 | 44 (32.1%) | 67 (30.3%) | .72 |
| Prior EB on intra-abdominal culture | 5 (1.2%) | 1 (0.7%) | >.99 | 3 (2.2%) | 29 (13.1%) | <.01 |
Abbreviations: BSI, bloodstream infection; EB, Enterobacterales; ESBL, extended-spectrum beta-lactamase; IQR, interquartile range.
While other characteristics were also assessed, only the variables included in the final predictive model or otherwise felt to be of biologic interest are reported in this table.
All values are reported as number (percentage of total), unless otherwise noted.
Defined by a drop in systolic blood pressure of > 30 mm Hg and diastolic blood pressure of > 20 mm Hg, requirement for vasopressor, or systolic blood pressure < 90 mm Hg.
Assessed at the time of EB BSI, including any corticosteroid dose.
Receipt of any of the following agents in the 30 d preceding EB BSI: abatacept, anakinra, apremilast, azathioprine, cyclophosphamide, cyclosporine, denosumab, hydroxychloroquine, methotrexate, mycophenolate, rituximab, secukinumab, sulfasalazine, tocilizumab, tofacitinib, infliximab, adalimumab, certolizumab, golimumab, or etanercept.
Defined as an absolute neutrophil count of < 500 cells/μl.